title: Genotyping and clinical characteristics of multidrug and extensively drug-resistant tuberculosis in a tertiary care tuberculosis hospital in China.
abstract: BACKGROUND
  There is a lack of information on the clinical characteristics of multidrug-resistant (MDR) tuberculosis (TB) and extensively drug-resistant (XDR) TB in the Jiangxi Province of China; furthermore, data have not been reported on the utility of mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) analyses in genotyping Mycobacterium tuberculosis strains isolated from this region. The aim of this study was to analyse the clinical features of patients with MDR and XDR TB from Jiangxi Province and to evaluate the discriminatory power of the 15-loci MIRU-VNTR method.
  
  
  METHODS
  A retrospective study was conducted on patients diagnosed with MDR and XDR TB at the Jiangxi Chest Hospital from July 2010 to June 2011. The RD105 deletion-targeted multiplex PCR (DTM-PCR) and the 15-loci MIRU-VNTR method were used to determine the genetic background of the identified MDR and XDR M. tuberculosis clinical isolates.
  
  
  RESULTS
  Of 804 M. tuberculosis clinical isolates, 159 (159/804, 19.8%) of the isolates were identified as MDR with first-line drug susceptibility testing. Of the 123 available MDR isolates, 13 (13/123, 10.6%) were XDR. The RD105 deletion-targeted multiplex PCR method identified 85 (85/110, 77.3%) MDR and 12 (12/13, 92.3%) XDR isolates as the Beijing genotype. MIRU-VNTR cluster analysis demonstrated that 101 MDR and 13 XDR strains had unique genotype patterns; the remaining 9 MDR strains were in 4 clusters, namely 1 cluster with 3 strains and 3 clusters with 2 strains, resulting in a low clustering rate (4.06%). The Hunter-Gaston discriminatory index (HGDI) of the 15-loci MIRU-VNTR method was as high as 0.992. In addition, clinical surveys showed that 87 (87/110, 79.1%) MDR TB patients and 10 (10/13, 76.9%) XDR TB patients had been previously treated. Diabetes mellitus was the most common comorbidity in both MDR TB (16/110, 14.5%) and XDR TB (2/13, 15.4%) patients.
  
  
  CONCLUSIONS
  Based on our preliminary data, the MDR and XDR M. tuberculosis clinical isolates identified at the Jiangxi Chest Hospital were genetically diverse and clustered at a low frequency. The 15-loci MIRU-VNTR method showed high discriminatory power and may be used as a first-line genotyping tool in investigating the molecular epidemiology of M. tuberculosis in Jiangxi, China. Decisive measures are urgently needed to effectively prevent and manage MDR and XDR tuberculosis in this province.
authors.affiliation: Division of Respiratory Diseases, Department of Internal Medicine, The 3rd Affiliated Hospital of Sun Yat-sen University, Institute of Respiratory Diseases of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou 510630, China.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Yuan
authors.forename: Tiantuo
authors.initials: T
authors.lastname: Zhang
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Kawakami
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Zhu
authors.forename: Wenzheng
authors.initials: W
authors.lastname: Zheng
authors.forename: Hongtao
authors.initials: H
authors.lastname: Li
authors.forename: Guofang
authors.initials: G
authors.lastname: Deng
authors.forename: Shaohua
authors.initials: S
authors.lastname: Tu
authors.forename: Weiyou
authors.initials: W
authors.lastname: Liu
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D054908:Extensively Drug-Resistant Tuberculosis / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005838:Genotype; D006801:Humans; D020071:Interspersed Repetitive Sequences; D008297:Male; D008826:Microbial Sensitivity Tests; D018598:Minisatellite Repeats; D058889:Molecular Typing; D009169:Mycobacterium tuberculosis / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D010802:Phylogeny; D011110:Polymorphism, Genetic; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents