Rapid emergence of Mycobacterium tuberculosis bedaquiline resistance: lessons to avoid repeating past errors

[摘要] ExtractBedaquiline (BDQ) has demonstrated potent clinical activity against multidrug-resistant (MDR) and extensively drug-resistant (XDR) Mycobacterium tuberculosis complex strains [1xe2x80x933]. It has now been used in >50 countries; and it is estimated that xe2x88xbc2500 patients had been treated with BDQ by the end of 2015. In spite of its recent clinical use; there are few reports of BDQ-resistant strains [4; 5]. Mutations in the rv0678 gene encoding the MmpL5 efflux pump repressor generate low-level BDQ resistance and clofazimine (CFZ) cross-resistance [6]. To our knowledge; this is the sole mechanism of BDQ resistance described in clinical strains [4; 5]. Despite its introduction in France in 2011 for XDR- and MDR-tuberculosis (TB) treatment; we report herein four BDQ-resistant cases; and discuss strategies to avoid a surge of BDQ resistance.

[学科分类] 呼吸医学