TY - JOUR T1 - Multi-drug resistant tuberculosis in Finland; treatment outcome and the role of whole genome sequencing JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00214-2022 SP - 00214-2022 AU - Virve Korhonen AU - Pia Kivelä AU - Marjo Haanperä AU - Hanna Soini AU - Tuula Vasankari Y1 - 2022/01/01 UR - http://openres.ersjournals.com/content/early/2022/09/22/23120541.00214-2022.abstract N2 - Treatment of multi-drug resistant tuberculosis (MDR-TB) is a global challenge requiring long treatment with costly drugs. We assessed treatment combinations, outcome and the utility of whole genome sequencing (WGS) in MDR-TB cases.Clinical, demographic, and microbiological data were obtained of all patients with MDR-TB who started treatment in Finland in 2007–2016. Definitions of MDR, pre-extensively drug-resistant TB (pre-XDR) and XDR-TB were those applicable at the study period. Treatment outcome was defined according to WHO guidelines. M. tuberculosis isolates were analysed by WGS in addition to routinely performed phenotypic drug susceptibility testing and genotyping.Among the 47 cases, 35 (74%) had a successful treatment outcome. Risk factors for non-successful outcome were Finnish origin and XDR. Almost ninety percent of our cases had an adverse event for at least one drug. Phenotypic and WGS drug resistance results were fully concordant for isoniazid, fluoroquinolones, and amikacin, and >90% concordant for rifampicin, pyrazinamide, kanamycin and capreomycin. More than 60% of phenotypically ethambutol susceptible isolates were genotypically resistant. The results of the rifampicin and isoniazid NAA tests performed for the isolates were identical to the WGS results except for three isolates having uncommon resistance mutations not included in the NAATs. WGS did not reveal unexpected clustering.More training is needed for physicians treating MDR-TB, and especially XDR-TB, to improve treatment outcome. Phenotypical drug susceptibility testing was shown to be unreliable for ethambutol. WGS can aid in the selection of optimal treatment regimen in the future.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: V. Korhonen has nothing to disclose.Conflict of interest: P. Kivelä has nothing to disclose.Conflict of interest: M. Haanperä has nothing to disclose.Conflict of interest: H. Soini has nothing to disclose.Conflict of interest: T. Vasankari has nothing to disclose. ER -