ArticleAmerican journal of respiratory and critical care medicine2026
Transmission of bedaquiline-resistant Mycobacterium tuberculosis in KwaZulu-Natal, South Africa.
Article in American journal of respiratory and critical care medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- We Are Underprepared for Bedaquiline Resistance: A Call for Clinical and Programmatic Readiness.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Bedaquiline resistance: a predictable consequence of a game-changing drug?ASM case reports · 2026Article
- A Case of Transmission of Bedaquiline- and Linezolid-Resistant Tuberculosis.International journal of molecular sciences · 2026Article
- Article
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Authors and funding
17 authors.
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Abstract
rationaleBedaquiline is a critical component of new drug-resistant tuberculosis (TB) treatment regimens. Emergence of bedaquiline-resistant Mycobacterium tuberculosis (Mtb) threatens to undermine already limited treatment options. Understanding the evolution and transmission of bedaquiline-resistant strains is a high priority for TB control.
objectivesWe evaluated the prevalence, strain genetic diversity, and transmission of bedaquiline resistance among people with drug-resistant TB.
methodsWe conducted a prospective study of all patients diagnosed with TB resistant to a fluoroquinolone or a second-line injectable drug in KwaZulu-Natal province, South Africa, between 2018 and 2022. We utilized whole genome sequencing (WGS), SNP-based clustering, and Bayesian reconstruction of transmission trees to examine the genomic characteristics and transmission networks of bedaquiline-resistant Mtb strains. MEASUREMENTS AND MAIN
resultsWe enrolled 843 of 1070 eligible individuals and obtained WGS for 632 participants. Of the sequenced isolates, 14% (n = 89) were genotypically bedaquiline-resistant, 67% (n = 60) of which were in clusters of recently transmitted infections. Resistance was present across all Mtb lineages and across strains with different resistance profiles to other TB drugs. We observed no differences in lineage distribution, bedaquiline resistance-associated mutations, or drug resistance profiles between clustered and nonclustered isolates. Transmission inference and geographic reconstruction of transmission networks indicate considerable unsampled cases within transmission networks.
conclusionsBedaquiline resistance was common in this cohort of individuals with highly drug-resistant TB. Most bedaquiline-resistant infections were attributable to recent transmission, involving Mtb strains with diverse genetic backgrounds and a variety of causative mutations. The diversity and transmissibility of bedaquiline-resistant Mtb signal a growing public health threat.
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