Anne-Laure Bañuls, Sokleaph Cheng, Thi Van Anh Nguyen, Sophan Sam, Mallorie Hide, Sok Heng Pheng, Tan Eang Mao, Gauthier Delvallez, Alexandra Kerleguer, Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP), Ministry of Health [Phnom Penh], Unité de biologie médicale - Medical biology unit [Phnom Penh, Cambodia], Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Du gène à l'écosystème (MIVEGEC-GeneSys), Pathogènes, Environnement, Santé Humaine (EPATH), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Centre de Recherche en Ecologie et Evolution de la Santé (CREES), Institut de Recherche pour le Développement (IRD)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), National Center for Tuberculosis and Leprosy Control [Phnom Penh, Cambodia] (CENAT), Cambodian Health Committee, National Institute of Hygiene and Epidemiology [Hanoi, Vietnam] (NIHE), and This study was funded by the project of the International Joint Laboratory on Drug Resistance in South-East Asia (LMI DRISA), the French Embassy in Cambodia, the Cambodian Ministry of Education, Youth and Sports (MoEYS) and the PHC Lotus project 'Application of DNA chip technology for the development of diagnostic kits for rapid detection of drug‐resistant tuberculosis in Vietnam, Laos and Cambodia (2014–2018)' granted by the Ministry of Science and Technology (MOST) and the French Embassy, Vietnam. Sokleaph Cheng, PhD, was funded by the IRD PhD Grant program, ARTS.
Sokleaph Cheng,1– 3 Mallorie Hide,3– 5 Sok Heng Pheng,6 Alexandra Kerléguer,2 Gauthier Delvallez,2 Sophan Sam,7 Tan Eang Mao,6 Thi Van Anh Nguyen,3,8 Anne-Laure Bañuls3– 5 1Institut Pasteur du Cambodge and Ministry of Health, Phnom Penh, Cambodia; 2Medical Biology Laboratory, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; 3LMI Drug Resistance in South East Asia, Institut Pasteur du Cambodge, Phnom Penh, Cambodia; 4MIVEGEC, University of Montpellier, Institute of Research for Development, Centre National de la Recherche Scientifique, Montpellier, France; 5CREES (Centre de Recherche En Écologie Et Évolution de la Santé), Montpellier, France; 6National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia; 7Cambodian Health Committee, Phnom Penh, Cambodia; 8Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Martinique, VietnamCorrespondence: Sokleaph ChengInstitut Pasteur du Cambodge, No. 5, Monivong Boulevard, Phnom Penh 120210, CambodiaTel +855 12 222 684Email csokleaph@pasteur-kh.orgBackground: Due to the emergence of Mycobacterium tuberculosis (M.tb) clinical isolates resistant to most potent first-line drugs (FLD), second-line drugs (SLD) are being prescribed more frequently. We explore the genetic characteristics and molecular mechanisms of M.tb isolates phenotypically resistant to SLD, including pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) isolates.Methods: Drug-resistant (DR) M.tb isolates collected from 2012 to 2017 were tested using sequencing and phenotypic drug susceptibility testing. Genotypes were determined to explore their links with SLD resistance patterns.Results: Of the 272 DR M.tb isolates, 6 non-multidrug resistant (non-MDR) isolates were fluoroquinolones (FQ)-resistant, 3 were XDR and 16 were pre-XDR (14 resistant to FQ and 2 to second-line injectable drugs). The most frequent mutations in FQ-resistant and second-line injectable drugs resistant isolates were gyrA D94G (15/23) and rrs a1401g (3/5), respectively. Seventy-five percent of pre-XDR isolates and 100% of XDR isolates harbored mutations conferring resistance to pyrazinamide. All XDR isolates belonged to the Beijing genotype, of which one, named XDR+, was resistant to all drugs tested. One cluster including pre-XDR and XDR isolates was observed.Conclusion: This is the first description of SLD resistance in Cambodia. The data suggest that the proportion of XDR and pre-XDR isolates remains low but is on the rise compared to previous reports. The characterization of the XDR+ isolate in a patient who refused treatment underlines the risk of transmission in the population. In addition, genotypic results show, as expected, that the Beijing family is the main involved in pre-XDR and XDR isolates and that the spread of the Beijing pre-XDR strain is capable of evolving into XDR strain. This study strongly indicates the need for rapid interventions in terms of diagnostic and treatment to prevent the spread of the pre-XDR and XDR strains and the emergence of more resistant ones.Keywords: Mycobacterium tuberculosis, extensively drug-resistant tuberculosis, pre-extensively drug-resistant tuberculosis, fluoroquinolone, second-line injectable drugs