title: Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.
abstract: Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the "blank" countries without systematic data.
  
  
  
  Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance.
  
  
  
  A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs.
  
  
  
  The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali. bdiarra@icermali.org.|Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. bdiarra@icermali.org.
authors.forename: B
authors.identifier: 0000-0002-1795-9379
authors.initials: B
authors.lastname: Diarra
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: D
authors.initials: D
authors.lastname: Goita
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: S
authors.initials: S
authors.lastname: Tounkara
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: M
authors.initials: M
authors.lastname: Sanogo
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: B
authors.initials: B
authors.lastname: Baya
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: A C G
authors.initials: AC
authors.lastname: Togo
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: M
authors.initials: M
authors.lastname: Maiga
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: Y S
authors.initials: YS
authors.lastname: Sarro
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: A
authors.initials: A
authors.lastname: Kone
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: B
authors.initials: B
authors.lastname: Kone
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: O
authors.initials: O
authors.lastname: M'Baye
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: N
authors.initials: N
authors.lastname: Coulibaly
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: H
authors.initials: H
authors.lastname: Kassambara
authors.affiliation: Laboratoire National de Référence des Mycobactéries (LNR), Institut National de Recherche en Santé publique (INRSP), Bamako, Mali.
authors.forename: A
authors.initials: A
authors.lastname: Cisse
authors.affiliation: CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Belson
authors.affiliation: CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Polis
authors.affiliation: Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia.
authors.forename: J
authors.initials: J
authors.lastname: Otu
authors.affiliation: Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia.|Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Gehre
authors.affiliation: Vaccines and Immunity Theme, Atlantic Boulevard, Medical Research Council (MRC), Fajara, Banjul, The Gambia.|Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.|Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: M
authors.initials: M
authors.lastname: Antonio
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: S
authors.initials: S
authors.lastname: Dao
authors.affiliation: CCRB, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
authors.forename: S
authors.initials: S
authors.lastname: Siddiqui
authors.affiliation: Global Health, Northwestern University, Chicago, IL, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Murphy
authors.affiliation: Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: B C
authors.initials: BC
authors.lastname: de Jong
authors.affiliation: SEREFO Program, University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
authors.forename: S
authors.initials: S
authors.lastname: Diallo
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D015658:HIV Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D015995:Prevalence; D019233:Retreatment; D013183:Sputum / Q000382:microbiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D024841:Fluoroquinolones
keywords: Bamako; Mali; Tuberculosis Drug resistance