Routine Molecular Surveillance of Drug-Resistant Tuberculosis: Translating Mutation Proxies into Clinical Governance...

Area of Science:

• Molecular diagnostics
• Epidemiology
• Public Health

Background:

• Drug-resistant tuberculosis (TB) poses a significant challenge in high-burden areas.
• Timely detection of resistance and effective governance are crucial for TB control.
• Routine molecular diagnostics generate valuable data underutilized for surveillance.

Purpose of the Study:

• To analyze resistance-associated mutation proxies from routine molecular diagnostics in a high-burden setting.
• To assess the prevalence, distribution, and temporal trends of drug resistance in *Mycobacterium tuberculosis*.
• To evaluate the utility of routine data for population-level surveillance and clinical governance.

Main Methods:

• Retrospective analysis of 1386 *Mycobacterium tuberculosis* molecular diagnostic records (March 2021-December 2024).
• Identification of resistance-associated mutation proxies for isoniazid, fluoroquinolone, and second-line injectable agents.
• Examination of mutation prevalence by age, time, and facility, including temporal persistence analysis.

Main Results:

• Over 72% of records showed at least one resistance-associated mutation proxy.
• Isoniazid resistance was predominant (52.2% *katG*, 20.2% *inhA* mutations).
• Fluoroquinolone and second-line injectable resistance mutations were less common; heterogeneity and facility-level persistence were observed.

Conclusions:

• Routine molecular data reveals a substantial, heterogeneous burden of drug-resistant TB.
• Mutation proxy data can serve as early-warning indicators for clinical governance stress.
• Interpreting these trends supports surveillance, governance, and targeted interventions.