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Abstract

Objectives:The primary objective of this work was to examine the acquisition and spread of multi-drug resistant (MDR) tuberculosis (TB) in Ireland.Methods:All available Mycobacterium tuberculosis complex (MTBC) isolates (n = 42), from MDR-TB cases diagnosed in Ireland between 2001 and 2014, were analysed using phenotypic drug-susceptibility testing, Mycobacterial-Interspersed-Repetitive-Units Variable-Number Tandem-Repeat (MIRU-VNTR) genotyping, and whole-genome sequencing (WGS).Results:The lineage distribution of the MDR-TB isolates comprised 54.7% Euro-American, 33.3% East Asian, 7.2% East African Indian, and 4.8% Indo-Oceanic. A significant association was identified between the East Asian Beijing sub-lineage and the relative risk of an isolate being MDR. Over 75% of MDR-TB cases were confirmed in non-Irish born individuals and 7 MIRU-VNTR genotypes were identical to clusters in other European countries indicating cross-border spread of MDR-TB to Ireland. WGS data provided the first evidence in Ireland of in vivo microevolution of MTBC isolates from drug-susceptible to MDR, and from MDR to extensively-drug resistant (XDR). In addition, they found that the katG S315T isoniazid and rpoB S450L rifampicin resistance mutations were dominant across the different MTBC lineages.Conclusions:Our molecular epidemiological analyses identified the spread of MDR-TB to Ireland from other jurisdictions and its potential to evolve to XDR-TB.

Item Type:	Article
Authors/Creators:	Roycroft, E and O'Toole, RF and Fitzgibbon, MM and Montogmery, L and O'Meara, M and Downes, P and Jackson, S and O'Donnell, J and Laurenson, IF and McLaughlin, AM and Keane, J and Rogers, TR
Keywords:	tuberculosis, molecular epidemiology, drug resistance
Journal or Publication Title:	Journal of Infection
Publisher:	W B Saunders Co Ltd
ISSN:	0163-4453
DOI / ID Number:	10.1016/j.jinf.2017.10.002
Copyright Information:	© 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Related URLs:	Google Scholar: O'Toole, RF UTAS Profile: O'Toole, RF
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