Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

Isaac Darko Otchere; Portia Abena Morgan; Prince Asare; Stephen Osei-Wusu; Samuel Yaw Aboagye; Stephen Ofori Yirenkyi; Abdul Basit Musah; Emelia Konadu Danso; Georgina Tetteh-Ocloo; Theophilus Afum; Adwoa Asante-Poku; Clement Laryea; Yaw Adusi Poku; Frank Bonsu; Sebastien Gagneux; Dorothy Yeboah-Manu

doi:10.3389/fmicb.2022.1069292

Analysis of drug resistance among difficult-to-treat tuberculosis patients in Ghana identifies several pre-XDR TB cases

Front Microbiol. 2023 Jan 12:13:1069292. doi: 10.3389/fmicb.2022.1069292. eCollection 2022.

Authors

Isaac Darko Otchere¹, Portia Abena Morgan¹, Prince Asare¹, Stephen Osei-Wusu¹, Samuel Yaw Aboagye², Stephen Ofori Yirenkyi³, Abdul Basit Musah¹, Emelia Konadu Danso¹, Georgina Tetteh-Ocloo³, Theophilus Afum¹, Adwoa Asante-Poku¹, Clement Laryea⁴, Yaw Adusi Poku⁵, Frank Bonsu⁵, Sebastien Gagneux⁶, Dorothy Yeboah-Manu¹

Affiliations

¹ Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana.
² Institute for Environment and Sanitation Studies, College of Basic and Applied Sciences, University of Ghana, Accra, Ghana.
³ Eastern Regional Hospital, Koforidua, Ghana.
⁴ Chest Department, 37 Military Hospital, Accra, Ghana.
⁵ National Tuberculosis Control Program, Ghana Health Service, Accra, Ghana.
⁶ Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.

Abstract

Background: Resistance to tuberculosis (TB) drugs has become a major threat to global control efforts. Early case detection and drug susceptibility profiling of the infecting bacteria are essential for appropriate case management. The objective of this study was to determine the drug susceptibility profiles of difficult-to-treat (DTT) TB patients in Ghana.

Methods: Sputum samples obtained from DTT-TB cases from health facilities across Ghana were processed for rapid diagnosis and detection of drug resistance using the Genotype MTBDRplus and Genotype MTBDRsl.v2 from Hain Life science.

Results: A total of 298 (90%) out of 331 sputum samples processed gave interpretable bands out of which 175 (58.7%) were resistant to at least one drug (ANY^r); 16.8% (50/298) were isoniazid-mono-resistant (INH^r), 16.8% (50/298) were rifampicin-mono-resistant (RIF^r), and 25.2% (75/298) were MDR. 24 (13.7%) of the ANY^r were additionally resistant to at least one second line drug: 7.4% (2 RIF^r, 1 INH^r, and 10 MDR samples) resistant to only FQs and 2.3% (2 RIF^r, 1 INH^r, and 1 MDR samples) resistant to AMG drugs kanamycin (KAN), amikacin (AMK), capreomycin (CAP), and viomycin (VIO). Additionally, there were 4.0% (5 RIF^r and 2 MDR samples) resistant to both FQs and AMGs. 81 (65.6%) out of 125 INH-resistant samples including INH^r and MDR had katG-mutations (MT) whereas 15 (12%) had inhApro-MT. The remaining 28 (22.4%) had both katG and inhA MT. All the 19 FQ-resistant samples were gyrA mutants whereas the 10 AMGs were rrs (3), eis (3) as well as rrs, and eis co-mutants (4). Except for the seven pre-XDR samples, no sample had eis MT.

Conclusion: The detection of several pre-XDR TB cases in Ghana calls for intensified drug resistance surveillance and monitoring of TB patients to, respectively, ensure early diagnosis and treatment compliance.

Keywords: Ghana; drug resistance; monitoring; pre-XDR-TB; screening; treatment; tuberculosis.

Grants and funding

MR/P028071/1/MRC_/Medical Research Council/United Kingdom