Additional resistance to any fluoroquinolones among multidrug-resistant mycobacterium tuberculosis isolates from North Coastal Andhra Pradesh, India

Abstract

Fluoroquinolones (FQ) are integral part of multidrug resistant/rifampicin resistant tuberculosis (MDRTB/ RR TB) treatment regimens. FQ resistance in MDR-TB lead to narrower treatment options and poor treatment outcomes. Hence proportion of FQ resistance among MDR-TB and cross-resistance among FQ in MDR-TB isolates was studied. This is the first study from North Coastal Andhra Pradesh, India. A cross-sectional study was conducted on 21,474 sputum samples from January-December 2018 & 833 culture isolates (rifampicin resistant detected by GeneXpert MTB / RIF assay & MDR-TB detected by direct and indirect GenoType MTBDRplus Assay) were analysed for FQ resistance by Mycobacterium Growth Indicator Tube (MGIT) for ofloxacin (Ofx) 2.0 μg/mL, levofloxacin (Lfx) 1.5 μg/mL & moxifloxacin (Mfx) 2.0 μg/mL. Among 833 culture isolates, 119 (14.2%) showed resistance to FQ which included 90 (10.8%) Ofx and Lfx resistance isolates but still sensitive to Mfx, 16 (1.92%) with resistance to all FQ tested, 12 Ofx monoresistance & 1 Lfx monoresistance. Mfx monoresistance was absent. Mfx sensitive isolates are 714 (85.7%) and were always sensitive to Ofx and Lfx. Cross-resistance was not complete. MDR-TB/RR TB is 4.1% among all TB patients. Additional resistance to FQ, among MDR-TB patients was seen in 14.2% patients.