@article{Park:2022:10.1186/s12879-022-07329-y,
author = {Park, M and Lalvani, A and Satta, G and Kon, OM},
doi = {10.1186/s12879-022-07329-y},
journal = {BMC Infectious Diseases},
pages = {1--10},
title = {Evaluating the clinical impact of routine whole genome sequencing in tuberculosis treatment decisions and the issue of isoniazid mono-resistance},
url = {http://dx.doi.org/10.1186/s12879-022-07329-y},
volume = {22},
year = {2022}
}

Download

TY  - JOUR
AB  - BackgroundThe UK has implemented routine use of whole genome sequencing (WGS) in TB diagnostics. The WHO recommends addition of a fluoroquinolone for isoniazid mono-resistance, so early detection may be of use. The aim of this study was to describe the clinical utility and impact of WGS on treatment decisions for TB in a low incidence high resource clinical setting. The clinical turnaround time (TAT) for WGS was analysed in comparison to TB PCR using Xpert MTB/RIF (Cepheid, Sunnyvale, CA) results where available and subsequent phenotypic drug susceptibility testing (DST) when required.MethodsThis was a retrospective analysis of TB cases from January 2018 to March 2019 in London. Susceptibility and TAT by WGS, phenotypic DST, TB PCR using Xpert MTB/RIF were correlated to drug changes in order to describe the utility of WGS on treatment decisions on isoniazid mono-resistance in a low incidence high resource setting.Results189 TB cases were identified; median age 44 years (IQR 28–60), m:f ratio 112:77, 7 with HIV and 6 with previous TB. 80/189 cases had a positive culture and WGS result. 50/80 were fully sensitive to 1st line treatment on WGS, and the rest required additional DST. 20/80 cases required drug changes; 12 were defined by WGS: 8 cases had isoniazid mono-resistance, 2 had MDR-TB, 1 had isoniazid and pyrazinamide resistance and 1 had ethambutol resistance. The median TAT for positive culture was 16 days (IQR 12.5–20.5); for WGS was 35 days (IQR 29.5–38.75) and for subsequent DST was 86 days (IQR 69.5–96.75), resulting in non-WHO regimens for a median of 50.5 days (IQR 28.0–65.0). 9/12 has TB PCRs (Xpert MTB/RIF), with a median TAT of 1 day.ConclusionWGS clearly has a substantial role in our routine UK clinical settings with faster turnaround times in comparison to phenotypic DST. However, the majority of treatment changes defined by WGS were related to isoniazid resistance and given the 1 month TAT for WGS, it would be preferable
AU  - Park,M
AU  - Lalvani,A
AU  - Satta,G
AU  - Kon,OM
DO  - 10.1186/s12879-022-07329-y
EP  - 10
PY  - 2022///
SN  - 1471-2334
SP  - 1
TI  - Evaluating the clinical impact of routine whole genome sequencing in tuberculosis treatment decisions and the issue of isoniazid mono-resistance
T2  - BMC Infectious Diseases
UR  - http://dx.doi.org/10.1186/s12879-022-07329-y
UR  - https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-022-07329-y
UR  - http://hdl.handle.net/10044/1/96329
VL  - 22
ER  - 

Download