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Molecular characterization of para-aminosalicylic acid resistant Mycobacterium tuberculosis clinical isolates in southwestern China

Authors Luo M, Li K, Zhang H, Yan X, Gu J, Zhang Z, Chen Y, Li J, Wang J, Chen Y

Received 4 March 2019

Accepted for publication 22 May 2019

Published 24 July 2019 Volume 2019:12 Pages 2269—2275

DOI https://doi.org/10.2147/IDR.S207259

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 2

Editor who approved publication: Dr Joachim Wink


Ming Luo,1 Kun Li,1 Huizheng Zhang,1 Xiaofeng Yan,2 Jing Gu,3 Zhen Zhang,4 Yu Chen,5 Jungang Li,1 Jing Wang,1 Yaokai Chen1

1Central Laboratory, Chongqing Public Health Medical Center, Chongqing 400036, People’s Republic of China; 2Department of Tuberculosis, Chongqing Public Health Medical Center, Chongqing 400036, People’s Republic of China; 3Key Laboratory of Special Pathogens and Biosafety, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, People’s Republic of China; 4Department of Pharmacy, Chongqing Public Health Medical Center, Chongqing 400036, People’s Republic of China; 5Department of Medical Records, Chongqing Public Health Medical Center, Chongqing 400036, People’s Republic of China

Purpose: The aim of this study is to investigate para-aminosalicylic acid (PAS) resistance-related gene mutations in clinical Mycobacterium tuberculosis (MTB) isolates and analyze the associated risk factors in southwestern China.
Patients and methods: Total 122 PAS-resistant and 55 PAS-susceptible clinical isolates were obtained from Chongqing Public Health Medical Center between April 2014 and January 2018. Drug susceptibility test was performed, and the PAS resistance-related genes were sequenced.
Results: PAS-resistant strains were more likely to resist streptomycin (OR: 9.5, 95% CI: 3.87-23.3; P<0.01), isoniazid (OR: 5.98, 95% CI: 2.14–16.76; P<0.01), rifampin (OR: 5.01, 95% CI: 2.11–11.88; P<0.01), ethambutol (OR: 2.79, 95% CI: 1.44–5.4; P<0.01), levofloxacin (OR: 2.56, 95% CI: 1.33–4.93; P<0.01), and amikacin (OR: 4.29, 95% CI: 1.70–10.83; P<0.01). The sequencing results showed that 112 (91.8%) PAS-resistant strains harbored 30 different mutations in folC, thyA, and ribD. Mutations in folC were the most commonly observed in PAS-resistant isolates (54.5%, 61/112), followed by mutations in thyA and ribD. Residues I43 in folC, R235 in thyA, and −11G in upstream of ribD were hotspots for mutation sites.
Conclusion: PAS drug resistance in MTB in southwestern China is mainly caused by mutations in folC, thyA, and ribD, among which folC was the most frequent mutation. Some mutation hotspots exist in the three genes, which accounts for about 80% of total mutations. These results highlight the possibility of developing molecular diagnostic methods for PAS-resistant tuberculosis in the future.

Keywords: Mycobacterium tuberculosis, para-aminosalicylic acid, resistance, molecular characteristic, southwestern China

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