title: Molecular detection of fluoroquinolone-resistance in multi-drug resistant tuberculosis in Cambodia suggests low association with XDR phenotypes.
abstract: BACKGROUND
  Drug susceptibility testing (DST) remains an important concern for implementing treatment of MDR tuberculosis patients. Implementation of molecular tests for drug resistance identification would facilitate DST particularly in developing countries where culturing is difficult to perform. We have characterized multidrug resistant strains in Cambodia using MDTDRsl tests, drug target sequencing and phenotypic tests.
  
  
  METHODS
  A total of 65 non-MDR and 101 MDR TB isolates collected between May 2007 and June 2009 were tested for resistance to fluoroquinolones and aminoglycosides/cyclic peptides using the GenoType® MTBDRsl assay and gene sequencing. Rifampicin resistance (RMP-R) was tested using gene sequencing and genotyping was assessed by spoligotyping.
  
  
  RESULTS
  A total of 95 of the 101 MDR strains were confirmed to be RMP-R by rpoB gene sequencing. Fourteen of the 101 MDR isolates (14%) carried a gyrA mutation associated with fluoroquinolone-resistance (FQ-R) (detected by the MTBDRsl assay and sequencing) compared with only 1 (1.5%) of the 65 non-MDR strains. Only 1 (1%) of the MDR isolates was found to be XDR TB. The MDR group contained a higher proportion of Beijing or Beijing like strains (58%) than the non MDR group (28%). This percentage is higher in MDR FQ-R strains (71%).
  
  
  CONCLUSIONS
  The new GenoType® MTBDRsl assay combined with molecular tests to detect RMP-R and isoniazid resistance (INH-R) represents a valuable tool for the detection of XDR TB. In Cambodia there is a low rate of XDR amongst MDR TB including MDR FQ-R TB. This suggests a low association between FQ-R and XDR TB. Strain spoligotyping confirms Beijing strains to be more prone to accumulate antibiotic resistance.
authors.affiliation: Mycobacteriology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.
authors.forename: Corinne
authors.initials: C
authors.lastname: Surcouf
authors.forename: Seiha
authors.initials: S
authors.lastname: Heng
authors.forename: Catherine
authors.initials: C
authors.lastname: Pierre-Audigier
authors.forename: Véronique
authors.initials: V
authors.lastname: Cadet-Daniel
authors.forename: Amine
authors.initials: A
authors.lastname: Namouchi
authors.forename: Alan
authors.initials: A
authors.lastname: Murray
authors.forename: Brigitte
authors.initials: B
authors.lastname: Gicquel
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guillard
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology*; D002160:Cambodia; D027081:DNA Gyrase / Q000235:genetics; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024841:Fluoroquinolones / Q000494:pharmacology*; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D010641:Phenotype; D017422:Sequence Analysis, DNA; D018088:Tuberculosis, Multidrug-Resistant / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents; D004269:DNA, Bacterial; D024841:Fluoroquinolones; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit; D027081:DNA Gyrase