ArticleOpen forum infectious diseases2026
Extensive Endemic Transmission of Multidrug-Resistant
Article in Open forum infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
15 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: The proportion of multidrug-resistant tuberculosis (MDR-TB) cases is increasing in Bhutan. We conducted the first retrospective genomic-epidemiological study to provide insights into the population structure, resistance patterns, and recent transmission in Bhutan. Methods: Whole genome sequencing was performed on randomly selected drug-resistant (DR-TB) and drug-sensitive TB (DS-TB) isolates from Bhutan, collected between 2018 and 2022 at the Microbiological Diagnostic Unit Public Health Laboratory in Melbourne, Australia. Bioinformatic analysis was performed to identify drug-resistance mutations and genomic clustering of cases. Results: Approximately 40% of DR-TB and 2.5% of DS-TB were sequenced each year. Of the 203 sequences that passed the quality control, 126 (62.1%) were MDR-TB and 15 (7.4%) were isoniazid-resistant TB. There were 4 different circulating lineages, with the majority belonging to lineage 2 (86.2%). Using a SNP-threshold of ≤12 SNPs, 71% of sequences formed 12 genomic clusters; the largest comprised 88% of all MDR-TB sequences and spanned the entire study period and the country. These cases were highly clonal, with a mean pairwise SNP distance of 10 (range 0-25). Phylogenetic analysis with publicly available international sequence data showed that this MDR-TB cluster formed a distinct clade. Conclusions: Contrary to current assumptions of repeat importations, the major burden of MDR-TB in Bhutan appears to be due to recent local transmission resulting in a large endemic cluster, advocating for targeted and enhanced contact tracing and screening for this MDR-TB clade. This study highlights the significant value of investing in TB genomics in resource-limited settings to gain actionable insights to inform policy decisions.
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