Patel Minaxi H, Kanodia Kamla, Nigam Lovelesh, Patel Rashmi, Suthar Kamlesh, Patel Himanshu, Kute Vivek, Engineer Divyesh, Chauhan Sanshriti, Meshram Hari Shankar
From the Microbiology Section, Institute of Kidney Diseases and Research Centre and Institutes of Transplantation Science, Civil Hospital, Ahmedabad, Gujarat, India.
Exp Clin Transplant. 2023 Apr;21(4):317-323. doi: 10.6002/ect.2022.0408.
There are scarce data on the incidence and resistance pattern of rifampicin-resistant Mycobacterium tuberculosis among kidney transplant recipients.
This is a retrospective, single- center study of kidney transplantrecipients suspected of M. tuberculosis infection. The GeneXpert assay we used detected mutations in the rpoB gene that confer rifampicin resistance using 5 overlapping probes (A, B, C, D, and E). The probes can detect mutations in the codons 507 to 511 (probe A), 511 to 518 (probe B), 518 to 523 (probe C), 523 to 529 (probe D), and 529 to 533 (probe E).We also detailed the treatment protocol and outcomes of kidney transplantrecipients infected with rifampicin-resistant M. tuberculosis.
In total, 2700 samples were processed during the period from October 2018 to February 2022 with successful results in 2640 samples (97.04%). One hundred and ninety (7.19%) samples were positive for M.tuberculosis, and rifampicin resistance was detected in 12 (0.45%) cases (11 pulmonary, 1 genitourinary). The most common rpoB mutation was located in the region of probe E (75.0%), followed by probe A (16.6%) and in 1 combination probe DE (8.33%). The rpoB mutations were not observed in probe B and probe C. Six patients received bedaquiline-based treatmentfor a short course of 11 months, whereas the other 6 patients required a long course of 18 to 20 months. Three patients died, 2 were lost to follow-up, and 7 were cured. During treatment, 4 patients experienced acute rejection, and 1 graft loss was reported.
We report for the first time the incidence and pattern of rifampicin resistance among kidney transplant recipients with tuberculosis infection. Further investigations are required for exploring the molecular and clinical phenotypes.
关于肾移植受者中耐利福平结核分枝杆菌的发病率和耐药模式的数据稀缺。
这是一项针对疑似结核分枝杆菌感染的肾移植受者的回顾性单中心研究。我们使用的GeneXpert检测通过5个重叠探针（A、B、C、D和E）检测赋予利福平耐药性的rpoB基因突变。这些探针可检测密码子507至511（探针A）、511至518（探针B）、518至523（探针C）、523至529（探针D）以及529至533（探针E）中的突变。我们还详细介绍了感染耐利福平结核分枝杆菌的肾移植受者的治疗方案和结局。
在2018年10月至2022年2月期间共处理了2700份样本，2640份样本（97.04%）检测成功。190份样本（7.19%）结核分枝杆菌呈阳性，12例（0.45%）检测到利福平耐药（11例肺部感染，1例泌尿生殖系统感染）。最常见的rpoB突变位于探针E区域（75.0%），其次是探针A（16.6%），还有1例为探针DE组合突变（8.33%）。未在探针B和探针C中观察到rpoB突变。6例患者接受了为期11个月的短程基于贝达喹啉的治疗，而其他6例患者需要18至20个月的长程治疗。3例患者死亡，2例失访，7例治愈。治疗期间，4例患者发生急性排斥反应，报告1例移植肾丢失。
我们首次报告了结核感染的肾移植受者中利福平耐药的发病率和模式。需要进一步研究以探索分子和临床表型。
