Clinical Implications of Molecular Drug Resistance Testing for Mycobacterium tuberculosis: A 2023 TBnet/RESIST-TB Consensus Statement

Authors

José Domínguez
Martin J Boeree
Emmanuelle Cambau
Dumitru Chesov
Francesca Conradie
Vivian Cox
Keertan Dheda
Andrii Dudnyk
Maha R Farhat
Sebastien Gagneux
Martin P Grobusch
Matthias I Gröschel
Lorenzo Guglielmetti
Irina Kontsevaya
Berit Lange
Frank van Leth
Christian Lienhardt
Anna M Mandalakas
Florian P Maurer
Matthias Merker
Paolo Miotto
Barbara Molina-Moya
Florence Morel
Stefan Niemann
Nicolas Veziris
Andrew Whitelaw
Charles R Horsburgh
Christoph Lange

Publication Date

4-1-2023

Journal

The Lancet Infectious Diseases

DOI

10.1016/S1473-3099(22)00875-1

PMID

36868253

PMCID

PMC11460057

PubMedCentral® Posted Date

10-8-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Humans, Mycobacterium tuberculosis, Microbial Sensitivity Tests, Antitubercular Agents, Tuberculosis, Multidrug-Resistant, Tuberculosis, Mutation

Abstract

Drug-resistant tuberculosis is a substantial health-care concern worldwide. Despite culture-based methods being considered the gold standard for drug susceptibility testing, molecular methods provide rapid information about the Mycobacterium tuberculosis mutations associated with resistance to anti-tuberculosis drugs. This consensus document was developed on the basis of a comprehensive literature search, by the TBnet and RESIST-TB networks, about reporting standards for the clinical use of molecular drug susceptibility testing. Review and the search for evidence included hand-searching journals and searching electronic databases. The panel identified studies that linked mutations in genomic regions of M tuberculosis with treatment outcome data. Implementation of molecular testing for the prediction of drug resistance in M tuberculosis is key. Detection of mutations in clinical isolates has implications for the clinical management of patients with multidrug-resistant or rifampicin-resistant tuberculosis, especially in situations when phenotypic drug susceptibility testing is not available. A multidisciplinary team including clinicians, microbiologists, and laboratory scientists reached a consensus on key questions relevant to molecular prediction of drug susceptibility or resistance to M tuberculosis, and their implications for clinical practice. This consensus document should help clinicians in the management of patients with tuberculosis, providing guidance for the design of treatment regimens and optimising outcomes.