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Journal of Clinical Microbiology, July 2006, p. 2333-2337, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00330-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Mutations Prevalent among Rifampin- and Isoniazid-Resistant Mycobacterium tuberculosis Isolates from a Hospital in Vietnam

M. Caws,1* Phan Minh Duy,1 Dau Quang Tho,1 Nguyen Thi Ngoc Lan,2 Dai Viet Hoa,2 and Jeremy Farrar1

Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam,1 Pham Ngoc Thach Hospital for Tuberculosis and Lung Diseases, Huong Vuong, District 5, Ho Chi Minh City, Vietnam2

Received 15 February 2006/ Returned for modification 5 April 2006/ Accepted 23 April 2006

Vietnam is ranked 13th among the WHO list of 22 high-burden countries, based upon estimated total number of tuberculosis cases. Despite having a model national tuberculosis program, consistently achieving and exceeding WHO targets for detection and cure, drug-resistant and multidrug-resistant tuberculosis cases continue to rise. Rapid multidrug-resistant tests applicable in this setting, coupled with effective treatment regimens, would be a useful tool in reversing this trend, allowing early identification of patients with multidrug-resistant tuberculosis and avoiding resistance-amplifying regimens. Sequencing of consecutive isolates identified by the National Tuberculosis Program showed 89% of isoniazid-resistant isolates could be detected by targeting just 2 codons, katG 315 and –15C->T in the inhA promoter, while rifampin resistance will be more complex to detect, with many different mutation and insertion events in rpoB. The most prevalent rifampin resistance-conferring mutations, as in other countries, were in rpoB codons 531 (43%), 526 (31%), and 516 (15%). However, a hybridization-based resistance test with probes targeting the 5 most common mutations would only detect 78% of rifampin-resistant isolates. Overall, these data suggest that rifampin resistance may be used as a surrogate marker for multidrug-resistant tuberculosis and that a sensitivity of between 70 to 80% may be possible for rapid molecular detection of multidrug-resistant tuberculosis in this setting.

* Corresponding author. Mailing address: Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 190 Ben Ham Tu, Quan 5, Ho Chi Minh City, Vietnam. Phone: 84 8 8384013. Fax: 84 8 8353904. E-mail: mcaws{at}hotmail.com.

Journal of Clinical Microbiology, July 2006, p. 2333-2337, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00330-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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