Deciphering the population dynamics and drug-resistance characteristics of extrapulmonary tuberculosis: genomic and clinical insights from a Chinese hospital.

Introduction: Extrapulmonary tuberculosis (EPTB) is characterized by atypical clinical symptoms, difficult diagnosis, and high mortality, so it is very important to know the prevalence and drug resistance (DR) status. Methods: This study analyzed 427 isolates of EPTB from a Chinese hospital. Drug susceptibility testing for widely used anti-TB drugs was performed. All isolates were subjected to whole-genome sequencing (WGS) to explore the molecular characteristics of resistance and to perform phylogenetic analysis. Clinical characteristics and DR patterns associated with Results: The number of EPTB strains exhibited a general upward trend, and most EPTB cases in this study were accompanied by PTB. The predominant types were tuberculosis of urinary system (29.98%), tuberculous meningitis (23.65%), and lymph node tuberculosis (22.72%). Quadratic regression revealed a decline in urinary system cases and an increase in lymph node cases. Lineage 2 accounted for 83.60% of isolates and was significantly associated with isoniazid (INH) and streptomycin (STR) resistance. Overall resistance rates were 13.58% for INH and 7.73% for rifampicin (RIF). Male sex was associated with higher DR risk (aOR = 1.63, p = 0.046). Common resistance mutations included Discussion: The predominance of lineage 2 and high rates of anti-tuberculosis drug resistance indicate that EPTB remains a clinically and epidemiologically significant problem.