Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia

Elias Alehegn; Alganesh Gebreyohanns; Bereket Woldeab Berhane; Jayne A Wright; Gadissa Bedada Hundie; Rozina Ambachew Geremew; Kasahun Gorems; Zenebe Gebreyohannes; Misikir Amare; Yeshiwork Abebaw; Getu Diriba; Betselot Zerihun; Amanuel Wondimu Gebremichael; Melkayehu Kassa; Addisu Gize

doi:10.2147/IDR.S415906

Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia

Infect Drug Resist. 2023 Aug 22:16:5511-5522. doi: 10.2147/IDR.S415906. eCollection 2023.

Authors

Elias Alehegn^{1

2}, Alganesh Gebreyohanns¹, Bereket Woldeab Berhane³, Jayne A Wright⁴, Gadissa Bedada Hundie¹, Rozina Ambachew Geremew¹, Kasahun Gorems¹, Zenebe Gebreyohannes¹, Misikir Amare⁵, Yeshiwork Abebaw⁵, Getu Diriba⁵, Betselot Zerihun⁵, Amanuel Wondimu Gebremichael⁵, Melkayehu Kassa¹, Addisu Gize^{1

6}

Affiliations

¹ Department of Microbiology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
² Addis Ababa City Administration, Farmers and Urban Agriculture Development Commission, Addis Ababa, Ethiopia.
³ Department of Pathology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
⁴ Jayne Wright Ltd, Pathology Consultancy, Ledbury, UK.
⁵ Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
⁶ CIHLMU Center for International Health, LMU University Hospital, Munich, Germany.

Abstract

Background: Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa.

Material and methods: A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant.

Results: From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes.

Conclusion: Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.

Keywords: Mycobacterium tuberculosis; drug resistance; extra pulmonary tuberculosis.