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Drug resistance in tuberculosis.

D A Mitchison¹

¹Medical Microbiology, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. dmitchis@sghms.ac.uk

The European Respiratory Journal

|February 3, 2005

Summary

The proportion method for testing Mycobacterium tuberculosis drug resistance may be unreliable due to bacterial clumping, not inoculum size differences. This method is time-consuming and not recommended as a standard diagnostic approach.

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Area of Science:

Microbiology
Infectious Diseases
Drug Resistance

Background:

Accurate drug susceptibility testing is crucial for treating Mycobacterium tuberculosis infections.
Standard methods include the absolute concentration, resistance ratio, and proportion methods.
The proportion method relies on inoculum size variations to assess drug resistance.

Purpose of the Study:

To evaluate the underlying hypothesis of the proportion method in drug susceptibility testing.
To investigate the causes of variation in Mycobacterium tuberculosis growth on drug-free media.

Main Methods:

The study analyzed ethionamide-resistant strains of Mycobacterium tuberculosis.
Bacterial clumping in the inoculum was assessed as a factor influencing growth proportions.

Main Results:

The hypothesis that inoculum size differences drive growth proportions was not supported.
Variations in growth on drug-free medium were attributed to bacillary clumping.
The proportion method can introduce errors in susceptibility testing.

Conclusions:

Bacterial clumping, not inoculum size, affects results in the proportion method.
The proportion method is less efficient and potentially less accurate than minimal inhibitory concentration determination.
The proportion method should not be adopted as a standard for Mycobacterium tuberculosis susceptibility testing.

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