纳入全基因组测序的埃塞俄比亚第三次全国结核病耐药性调查
The Ethiopian Third National Tuberculosis Drug Resistance Survey Incorporating Whole Genome Sequencing.
作者信息
Moga Shewki, Getahun Muluwork, Mohammed Zemedu, Alemu Ayinalem, Diriba Getu, Yenew Bazezew, Fikadu Dinka, Abebaw Yeshiwork, Amare Misikir, Tesfaye Ephrem, Kebede Abebaw, Yaregal Zelalem, Meaza Abyot, Mollalign Hilina, Dagne Biniyam, Tadesse Mengistu, Sinshaw Waganeh, Seid Getachew, Zerihun Betselot, Getu Melak, Tadesse Gemechu, Abdella Saro, Tollera Getachew, Admas Abayneh, Yilma Addisalem, Molla Yohannes, Mikru Fekadesselassie, Assefa Dawit, Girma Tefera, Feleke Beniam, Di Marco Federico, Cirillo Daniela M, Dean Anna, Maurizio Cabibbe Andrea, Klinkenberg Eveline
机构信息
Infectious Diseases Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Health Laboratory Services, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
出版信息
Open Forum Infect Dis. 2025 Jul 21;12(7):ofaf367. doi: 10.1093/ofid/ofaf367. eCollection 2025 Jul.
BACKGROUND
Drug-resistant tuberculosis (DR-TB) is a major challenge hindering global tuberculosis control. Ethiopia conducted a third national antituberculosis (TB) drug resistance survey, and this is the first survey to report on drug resistance using whole genome sequencing (WGS) in addition to genotypic and phenotypic test results. The aim of this study was to obtain up-to-date information regarding the magnitude and pattern of drug resistance in Ethiopia.
METHODS
A nationwide cross-sectional study was conducted in 217 health facilities across all Ethiopian regional states from August 2017 to January 2019. Sputum specimens were collected from patients with bacteriologically confirmed pulmonary TB to detect resistance to anti-TB drugs with Xpert MTB/RIF assay, culture-based phenotypic drug susceptibility testing (DST), and WGS with phylogenetic analysis.
RESULTS
The prevalence of rifampicin-resistant TB (RR-TB) was 1.07% (95% confidence interval [CI], .65%-1.74%) among new cases and 6.89% (95% CI, 4.02%-11.57%) among previously treated cases. The prevalence of isoniazid-resistant, rifampicin-susceptible TB was 4.15% (95% CI, 3.11%-5.53%) among new cases and 4.41% (95% CI, 1.97%-9.57%) among previously treated cases. While resistance to fluoroquinolones was detected in 1 RR-TB case, resistance to bedaquiline and linezolid was not detected in RR-TB cases. lineage 4 was the most common, followed by lineage 3 and lineage 1, with sublineage 4.2.2 being the most frequent.
CONCLUSIONS
The level of RR-TB remained low. Expanding baseline DST for isoniazid may help further lower the burden of DR-TB in Ethiopia.
背景
耐多药结核病（DR-TB）是阻碍全球结核病控制的一项重大挑战。埃塞俄比亚开展了第三次全国抗结核药物耐药性调查，这是首次除报告基因型和表型检测结果外，还利用全基因组测序（WGS）报告耐药性情况的调查。本研究的目的是获取埃塞俄比亚耐药性的程度和模式的最新信息。
方法
2017年8月至2019年1月在埃塞俄比亚所有地区州的217个医疗机构开展了一项全国性横断面研究。从痰涂片确诊为肺结核的患者中采集痰标本，采用Xpert MTB/RIF检测法、基于培养的表型药物敏感性试验（DST）以及进行系统发育分析的WGS来检测对抗结核药物的耐药性。
结果
新发病例中利福平耐药结核病（RR-TB）的患病率为1.07%（95%置信区间[CI]，0.65%-1.74%），既往治疗病例中为6.89%（95%CI，4.02%-11.57%）。新发病例中对异烟肼耐药、对利福平敏感的结核病患病率为4.15%（95%CI，3.11%-5.53%），既往治疗病例中为4.41%（95%CI，1.97%-9.57%）。虽然在1例RR-TB病例中检测到对氟喹诺酮类药物耐药，但在RR-TB病例中未检测到对贝达喹啉和利奈唑胺耐药。谱系4最为常见，其次是谱系3和谱系1，其中亚谱系4.2.2最为频繁。
结论
RR-TB水平仍然较低。扩大异烟肼的基线DST检测可能有助于进一步降低埃塞俄比亚DR-TB的负担。
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