Emergence during unsuccessful chemotherapy of multiple drug resistance in a strain of Mycobacterium tuberculosis.
Serial isolates of Mycobacterium tuberculosis were cultured from a patient who failed to respond to standard antituberculous chemotherapy. Isolates were cultured in March 1989, July 1989, December 1989 and May 1990. Each successive isolate was found to be resistant to a wider range of antituberculous drugs than its predecessors. The initial isolate was resistant to isoniazid and rifampin, the second isolate was also resistant to ethambutol, the third was also resistant to pyrazinamide, ansamycin (= rifabutin) and ofloxacin and the last isolate was also resistant to ciprofloxacin and sparfloxacin. All four isolates' bacteriophage typing profiles and DNA restriction fragment patterns determined by Southern blot hybridization using the IS6110/IS986 probes and the new probe pTBN12 were concordant. It was concluded that this patient was persistently infected with a single strain of Mycobacterium tuberculosis which developed resistance to a number of families of drugs but did not show any significant change in typing patterns. The problem of acquired multiple drug resistance, particularly to fluoroquinolones and rifamycins, represents a new challenge in tuberculosis therapy.
Unité de la Tuberculose et des Mycobactéries, Institut Pasteur, Paris, France.
N
N
Rastogi
B C
BC
Ross
B
B
Dwyer
K S
KS
Goh
S
S
Clavel-Sérès
V
V
Jeantils
P
P
Cruaud
D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D000904:Antibiotics, Antitubercular / Q000494:pharmacology / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001434:Bacteriophage Typing; D015139:Blotting, Southern; D002991:Clofazimine / Q000494:pharmacology / Q000627:therapeutic use; D015169:Colony Count, Microbial; D004269:DNA, Bacterial / Q000235:genetics; D004352:Drug Resistance, Microbial / Q000235:genetics*; D024841:Fluoroquinolones; D006801:Humans; D007538:Isoniazid / Q000494:pharmacology / Q000627:therapeutic use; D047029:Lactams, Macrocyclic; D008297:Male; D008826:Microbial Sensitivity Tests; D009169:Mycobacterium tuberculosis / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D012150:Polymorphism, Restriction Fragment Length; D012294:Rifamycins / Q000494:pharmacology / Q000627:therapeutic use; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D000904:Antibiotics, Antitubercular; D000995:Antitubercular Agents; D004269:DNA, Bacterial; D024841:Fluoroquinolones; D047029:Lactams, Macrocyclic; D012294:Rifamycins; D002991:Clofazimine; D007538:Isoniazid