title: Molecular epidemiology study of Mycobacterium tuberculosis and its susceptibility to anti-tuberculosis drugs in Indonesia.
abstract: BACKGROUND
  Genotyping of Mycobacterium tuberculosis helps to understand the molecular epidemiology of tuberculosis and to address evolutionary questions about the disease spread. Certain genotypes also have implications for the spread of infection and treatment. Indonesia is a very diverse country with a population with multiple ethnicities and cultures and a history of many trade and tourism routes. This study describes the first attempt to map the molecular epidemiology of TB in the Indonesian archipelago.
  
  
  METHODS
  From 2008 to 2011, 404 clinical specimens from sputum-smear (SS+) TB patients, age ≥15 years, were collected from 16 TB referral primary health centers (PHC) in 16 provincial capitals in Indonesia. Susceptibility testing to first line drugs was conducted for 262 samples using the agar proportion method as per WHO guidelines. Spoligotyping was done on all samples.
  
  
  RESULTS
  Ninety-three of the 404 samples (23 %) were from the Beijing family, making it the predominant family in the country. However, the geographic distribution of the family varied by region with 86/294 (29.3 %) in the western region, 6/72 (8.3 %) in the central region, and 2/72 (2.8 %) in the eastern region (p < 0.001). The predominant genotype in the central and eastern regions was from the East-African-Indian (EAI) family, comprising 15.3 % (11/72), and 26.3 % (10/38) of the isolates, respectively. Drug susceptibility to first-line anti-TB drugs was tested in 262 isolates. 162 (61.8 %) isolates were susceptible to all TB drugs, 70 (26.7 %) were mono-resistant 16 (6.1 %) were poly-resistant, and 14 (5.4 %) were multi-drug resistant (MDR). The proportion of Beijing family isolates in the susceptible, mono-resistant, poly-resistant, and MDR groups was 33/162 (20.4 %), 28/70 (40.0 %), 6/16 (37.5 %), and 3/14 (21.4 %), respectively. Overall, resistance of the Beijing family isolates to any of the first line TB drugs was significantly higher than non-Beijing families [37/71 (52.1 %) vs. 63/191 (33.0 %) (p-value = 0.003)].
  
  
  CONCLUSIONS
  The distribution of Mycobacterium tuberculosis genotypes in Indonesia showed high genetic diversity and tended to vary by geographic regions. Drug susceptibility testing confirmed that the Beijing family of M.tb in Indonesia exhibited greater resistance to first line anti-TB drugs than did other families.
authors: Institute for Vector and Reservoir Disease Control Research and Development (IVRDCRD), Salatiga, Indonesia. vivi_l@litbang.depkes.go.id.
authors: Vivi
authors: V
authors: Lisdawati
authors: Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD, MoH-RI, Jakarta, Indonesia. nellypuspa@gmail.com.
authors: Nelly
authors: N
authors: Puspandari
authors: Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD, MoH-RI, Jakarta, Indonesia. lutfahrifati@yahoo.com.
authors: Lutfah
authors: L
authors: Rif'ati
authors: Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD, MoH-RI, Jakarta, Indonesia. triyanisoekarso@gmail.com.
authors: Triyani
authors: T
authors: Soekarno
authors: Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD, MoH-RI, Jakarta, Indonesia. melatiwati@ymail.com.
authors: Melatiwati
authors: M
authors: M
authors: Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD, MoH-RI, Jakarta, Indonesia. syamsidar.litbang@gmail.com.
authors: Syamsidar
authors: S
authors: K
authors: Department of Clinical Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia. liesratna68@gmail.com.
authors: Lies
authors: L
authors: Ratnasari
authors: Department of Clinical Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia. nur.izzatun.nafsir@gmail.com.
authors: Nur
authors: N
authors: Izzatun
authors: Department of Clinical Pathology, Dr. Hasan Sadikin Hospital, Bandung, Indonesia. idaparwati2008@gmail.com.
authors: Ida
authors: I
authors: Parwati
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000995:Antitubercular Agents / Q000494:pharmacology; D004977:Ethambutol / Q000494:pharmacology; D005260:Female; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007538:Isoniazid / Q000494:pharmacology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000235:genetics*; D012293:Rifampin / Q000494:pharmacology; D013183:Sputum / Q000382:microbiology; D013307:Streptomycin / Q000494:pharmacology; D014376:Tuberculosis / Q000453:epidemiology / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000995:Antitubercular Agents; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D013307:Streptomycin