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European Respiratory Journal 02/14/2020 06:10
Bedaquiline is a highly effective drug for tuberculosis (TB) and is an important part of current regimens for drug-resistant TB. Bedaquiline resistance is rarely tested in operational settings. In a prospective cohort of 292 patients with drug-resistant TB and HIV starting bedaquiline in KwaZulu-Natal, South Africa, we whole genome sequenced isolates from 92 baseline culture positive patients. Five patients were infected with strains harbouring mutations associated with bedaquiline resistance, and an additional five acquired resistance mutations during treatment. Among the baseline culture positive patients, those with baseline or acquired resistance mutations had substantially worse clinical outcomes compared to patients without. Given the.

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