Abstract
A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. Drug unavailability, poor infection control, and schizophrenia likely fueled acquisition of additional resistance and bacterial fitness–related mutations over 2 decades.
Highlights
A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990
To determine the geographic origin of the 3-fold resistant TUR ancestor and to test for the putative independent introduction of 2 different rifampin-resistant cases to the Bela Crkva (BC) Hospital from other hospitals, we extended our Bayesian approach with a discrete trait model introducing the likely place of infection for each patient
In a retrospective approach using whole-genome sequencing (WGS)-based molecular epidemiology, Bayesian statistics, and detailed epidemiologic investigations, we show that MDR TB in Serbia is associated with nosocomial transmission at BC Hospital, likely accompanied by a fast progression to disease within 2 years
Summary
A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. The Study We subjected 1 MTBC isolate per patient to phenotypic drug susceptibility testing and whole-genome sequencing (WGS) (Appendix 1, https://wwwnc.cdc.gov/EID/ article/25/3/18-1220-App1.pdf). Susceptibility testing results showed that 19/110 (17.3%) MDR MTBC isolates were resistant to all first-line drugs, and 11/110 (10.0%) were classified as XDR (Appendix 1 Table 1).
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