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Kwak N, Lee S, Kim S, Song E, Yim JJ, Shim TS, Jeon D, Jhun BW, Seok KH, Kim S, Kwon S, Mok J. QMAC-DST for Rapid Detection of Drug Resistance in Pulmonary Tuberculosis Patients: A Multicenter Pre-Post Comparative Study. J Clin Med 2024; 13:2941. [PMID: 38792481 PMCID: PMC11122353 DOI: 10.3390/jcm13102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: This study explores the impact of QMAC-DST, a rapid, fully automated phenotypic drug susceptibility test (pDST), on the treatment of tuberculosis (TB) patients. Methods: This pre-post comparative study, respectively, included pulmonary TB patients who began TB treatment between 1 December 2020 and 31 October 2021 (pre-period; pDST using the Löwenstein-Jensen (LJ) DST (M-kit DST)) and between 1 November 2021 and 30 September 2022 (post-period; pDST using the QMAC-DST) in five university-affiliated tertiary care hospitals in South Korea. We compared the turnaround times (TATs) of pDSTs and the time to appropriate treatment for patients whose anti-TB drugs were changed based on these tests between the groups. All patients were permitted to use molecular DSTs (mDSTs). Results: A total of 182 patients (135 in the M-kit DST group and 47 in the QMAC-DST group) were included. The median TAT was 36 days for M-kit DST (interquartile range (IQR), 30-39) and 12 days for QMAC-DST (IQR, 9-15), with the latter being significantly shorter (p < 0.001). Of the total patients, 10 (5.5%) changed their anti-TB drugs based on the mDST or pDST results after initiating TB treatment (8 in the M-kit DST group and 2 in the QMAC-DST group). In the M-kit DST group, three (37.5%) patients changed anti-TB drugs based on the pDST results. In the QMAC-DST group, all changes were due to mDST results; therefore, calculating the time to appropriate treatment for patients whose anti-TB drugs were changed based on pDST results was not feasible. In the QMAC-DST group, 46.8% of patients underwent the first-line line probe assay compared to 100.0% in the M-kit DST group (p < 0.001), indicating that rapid QMAC-DST results provide quicker assurance of the ongoing treatment by confirming susceptibility to the current anti-TB drugs. Conclusions: QMAC-DST delivers pDST results more rapidly than LJ-DST, ensuring faster confirmation for the current treatment regimen.
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Affiliation(s)
- Nakwon Kwak
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (N.K.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Sangyeop Lee
- QuantaMatrix Inc., 131 Gasan digital 1-ro, Geumcheon-gu, Seoul 08506, Republic of Korea; (S.L.)
| | - Suyeoun Kim
- QuantaMatrix Inc., 131 Gasan digital 1-ro, Geumcheon-gu, Seoul 08506, Republic of Korea; (S.L.)
| | - Eunbee Song
- QuantaMatrix Inc., 131 Gasan digital 1-ro, Geumcheon-gu, Seoul 08506, Republic of Korea; (S.L.)
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea; (N.K.)
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Tae Sun Shim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Byung Woo Jhun
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kwang-Hyuk Seok
- Department of Laboratory Medicine, The Korean Institute of Tuberculosis, Cheongju 28158, Republic of Korea
| | - Saerom Kim
- Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Sunghoon Kwon
- QuantaMatrix Inc., 131 Gasan digital 1-ro, Geumcheon-gu, Seoul 08506, Republic of Korea; (S.L.)
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University School of Medicine, Busan 49241, Republic of Korea
- Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea
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Li S, Chen W, Feng M, Liu Y, Wang F. Drug Resistance and Molecular Characteristics of Mycobacterium tuberculosis: A Single Center Experience. J Pers Med 2022; 12:jpm12122088. [PMID: 36556308 PMCID: PMC9783070 DOI: 10.3390/jpm12122088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
In recent years, the incidence of tuberculosis (TB) and mortality caused by the disease have been decreasing. However, the number of drug-resistant tuberculosis patients is increasing rapidly year by year. Here, a total of 380 Mycobacterium tuberculosis (MTB)-positive formalin-fixed and paraffin-embedded tissue (FFPE) specimens diagnosed in the Department of Pathology of the Eighth Medical Center, Chinese PLA General Hospital were collected. Among 380 cases of MTB, 85 (22.37%) were susceptible to four anti-TB drugs and the remaining 295 (77.63%) were resistant to one or more drugs. The rate of MDR-TB was higher in previously treated cases (52.53%) than in new cases [(36.65%), p < 0.05]. Of previously treated cases, the rate of drug resistance was higher in females than in males (p < 0.05). Among specimens obtained from males, the rate of drug resistance was higher in new cases than in previously treated cases (p < 0.05). Of mutation in drug resistance-related genes, the majority (53/380, 13.95%) of rpoB gene carried the D516V mutation, and 13.42% (51/380) featured mutations in both the katG and inhA genes. Among the total specimens, 18.68% (71/380) carried the 88 M mutation in the rpsL gene, and the embB gene focused on the 306 M2 mutation with a mutation rate of 19.74%. Among the resistant INH, the mutation rate of −15 M was higher in resistance to more than one drug than in monodrug-resistant (p < 0.05). In conclusion, the drug resistance of MTB is still very severe and the timely detection of drug resistance is conducive to the precise treatment of TB.
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Kim H, Lee S, Jo E, Kim S, Kim H, Kim EG, Kwon S, Shin S. Performance of QuantaMatrix Microfluidic Agarose Channel system integrated with mycobacteria growth indicator tube liquid culture. Appl Microbiol Biotechnol 2021; 105:6059-6072. [PMID: 34328537 DOI: 10.1007/s00253-021-11446-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/22/2021] [Accepted: 07/03/2021] [Indexed: 11/25/2022]
Abstract
The QuantaMatrix Microfluidic Agarose Channel (QMAC) system was used for rapid drug susceptibility testing (DST). Here, we performed DST using QMAC integrated with the mycobacteria growth indicator tube (MGIT) liquid culture employing a specially designed cross agarose channel for the tuberculosis chip. MGIT-, QMAC-, and Löwenstein-Jensen (LJ)-DSTs were performed using 13 drugs. The protocol for QMAC-DST was optimized using the inoculum obtained after the disaggregation of Mycobacterium tuberculosis clumps in MGIT culture. The completion times of QMAC-DST and MGIT-DST were analyzed, and the results of all three DSTs were compared. Discrepant results were analyzed using line probe assays and DNA sequencing. Nontuberculous mycobacteria were distinguished using the ρ-nitrobenzoic acid inhibition test. The overall agreement rate of QMAT-DST and LJ-DST was 97.0% and that of QMAT-DST and MGIT-DST was 86.3%. An average turnaround time for DST was 5.4 days, which was considerably less than the time required for MGIT-DST. The overall time required to obtain DST results using QMAC-DST integrated with MGIT culture was an average of 18.6 days: 13.2 days for culture and identification and 5.4 days for DST. Hence, QMAC-DST integrated with liquid culture can be used to perform DSTs with short turnaround times and effective detection. KEY POINTS: • QMAC system can simultaneously perform phenotypic DST with 13 anti-TB drugs and PNB. • An optimized DST protocol led to a marked decrease in clumping in MGIT culture. • QMAC system integrated with MGIT liquid culture system reduced the turnaround time.
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Affiliation(s)
- Hyejin Kim
- Korean Institute of Tuberculosis, Osong, Cheongju-si, Chungcheongbuk-do, 28158, Republic of Korea.
| | - Sangyeop Lee
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea
| | - EunJi Jo
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea
| | - Suyeoun Kim
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea
| | - Haeun Kim
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea
| | - Eun-Geun Kim
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea.,Lowend Technologies, Dongan-gu, Anyang-si, Gyeonggi-do, 14056, Republic of Korea
| | - Sunghoon Kwon
- QuantaMatrix Inc., Seoul National Hospital CMI, Jongno-gu, Seoul, 03082, Republic of Korea.,Department of Electrical Engineering and Computer Science, Seoul National University, Seoul, 08826, Republic of Korea
| | - Soyoun Shin
- Korean Institute of Tuberculosis, Osong, Cheongju-si, Chungcheongbuk-do, 28158, Republic of Korea. .,Bestian Osong Hospital, Osong, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
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Atahan E, Saribas S, Demirci M, Babalık A, Akkus S, Balıkcı A, Satana D, Ziver T, Dinc HO, Keskin M, Ozbey D, Kocak BT, Gareayaghi N, Kirmusaoglu S, Tokman HB, Kocazeybek B. Evaluating the effectiveness of anti-tuberculosis treatment by detecting Mycobacterium tuberculosis 85B messenger RNA expression in sputum. J Infect Public Health 2020; 13:1490-1494. [PMID: 32616395 DOI: 10.1016/j.jiph.2020.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/08/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The antigen 85 complex (85B) is secreted in large quantities from growing mycobacteria and the presence of bacterial mRNA is an indicator of cell viability. The quantitative detection of 85B mRNA expression levels can be used to assess the success of anti-tuberculosis treatment outcomes to detect viable mycobacteria cells. Therefore, we evaluated the levels of 85B mRNA of Mycobacterium tuberculosis strains in patients with pulmonary tuberculosis. METHODS Thirty patients with primary tuberculosis were included in this study. The sputum specimens of patients were collected on days 0, 15, and 30 days and were cultured and evaluated by 85B mRNA-based RT-qPCR. RESULTS Overall, 23 of the studied tuberculosis strains were susceptible to the primary anti-tuberculosis antibiotics used in this study, 7 were resistant. By the 30th day of treatment, 85B mRNA was detected in only one of the susceptible strains, but in all 7 of the resistant strains, though the relative gene expression varied between the strains. This difference between the susceptible and resistant strains at day 30 was statistically significant (p < 0.05). CONCLUSION 85B mRNA expression levels could be used to follow up on primary tuberculosis cases. 85B mRNA seems to be a good diagnostic marker for monitoring anti-tuberculosis treatment outcomes.
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Affiliation(s)
- Ersan Atahan
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Pulmonary Diseases, Istanbul, Turkey
| | - Suat Saribas
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey.
| | - Mehmet Demirci
- Beykent University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Aylin Babalık
- Clinic of Chest Diseases, University of Health Sciences, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Seher Akkus
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Ahmet Balıkcı
- Clinic of Chest Diseases, University of Health Sciences, Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey
| | - Dilek Satana
- Istanbul University, Istanbul Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Tevhide Ziver
- Eastern Mediterranean University, Faculty of Health Sciences, Nutrition and Dietetic Department, Famagusta, Cyprus
| | - Harika Oyku Dinc
- Okan University, Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Melike Keskin
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Dogukan Ozbey
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Banu Tufan Kocak
- T.C. Health Ministry Erenkoy Mental Health and Neurology Training and Research Hospital, Istanbul, Turkey
| | - Nesrin Gareayaghi
- Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center, University of Health Sciences, Istanbul, Turkey
| | - Sahra Kirmusaoglu
- T.C. Haliç University, Faculty of Arts & Sciences, Department of Molecular Biology and Genetics, Istanbul, Turkey
| | - Hrisi Bahar Tokman
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
| | - Bekir Kocazeybek
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Medical Microbiology, Istanbul, Turkey
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Herricks T, Donczew M, Mast FD, Rustad T, Morrison R, Sterling TR, Sherman DR, Aitchison JD. ODELAM, rapid sequence-independent detection of drug resistance in isolates of Mycobacterium tuberculosis. eLife 2020; 9:56613. [PMID: 32401195 PMCID: PMC7263823 DOI: 10.7554/elife.56613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022] Open
Abstract
Antimicrobial-resistant Mycobacterium tuberculosis (Mtb) causes over 200,000 deaths each year. Current assays of antimicrobial resistance need knowledge of mutations that confer drug resistance, or long periods of culture time to test growth under drug pressure. We present ODELAM (One-cell Doubling Evaluation of Living Arrays of Mycobacterium), a time-lapse microscopy-based method that observes individual cells growing into microcolonies. ODELAM enables rapid quantitative measures of growth kinetics in as little as 30 hrs under a wide variety of environmental conditions. We demonstrate ODELAM’s utility by identifying ofloxacin resistance in cultured clinical isolates of Mtb and benchmark its performance with standard minimum inhibitory concentration (MIC) assays. ODELAM identified ofloxacin heteroresistance and the presence of drug resistant colony forming units (CFUs) at 1 per 1000 CFUs in as little as 48 hrs. ODELAM is a powerful new tool that can rapidly evaluate Mtb drug resistance in a laboratory setting.
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Affiliation(s)
- Thurston Herricks
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, United States
| | - Magdalena Donczew
- Department of Microbiology, University of Washington, Seattle, United States
| | - Fred D Mast
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, United States
| | - Tige Rustad
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, United States
| | - Robert Morrison
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, United States
| | - Timothy R Sterling
- Division of Infectious Disease, Department of Medicine, Vanderbilt University Medical Center, Nashville, United States
| | - David R Sherman
- Department of Microbiology, University of Washington, Seattle, United States
| | - John D Aitchison
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, United States.,Department of Pediatrics, University of Washington, Seattle, United States
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