Rapid Molecular Diagnosis Of Multidrug-Resistant Tuberculosis in South Eastern Region of Romania

<b>Background:</b> Since October 2013, molecular testing for Mycobacterium tuberculosis (MTB) detection has been available in the Microbiological Laboratory of Constanta Clinical Pulmonology Hospital, Romania. <b>Aim:</b> To assess the accessibility of patients to rapid molecular diagnosis of multidrugresistant (MDR) tuberculosis (TB) in a TB burden area of Romania, with increased TB morbidity in 2013 (91.5%000 inhabitants). <b>Material and Methods:</b> A prevalence study was performed among 1,148 TB patients hospitalized in Constanta Clinical Pulmonology Hospital, from January 2014 to December 2017, and all collected positive specimen of sputum were analyzed. Two commercial genetic tests (GeneXpert MTB/RIF and GenoType MTB-Drplus) were used for detecting resistant strains of MTB. Final diagnosis of MDR-TB was established by conventional phenotypic liquid and solid culture and drug sensitivity testing. Rifampicin (RIF, R) Resistance (RR), detected by GeneXpert MTB /RIF, is strongly associated with isoniazid (INH, H) resistance (85%). Line Probe Assay (LPA) MTB-DRplus by Hain method can detect both mutations in rpoB and katG genes, responsible for HR resistance. <b>Results:</b> 28 inpatients, mean aged 46.35 years old (limits from 25 to 83 years), were diagnosed with MDR-TB by phenotypic methods. The accessibility to GeneXpert testing was 53.57% (n= 15/28). MDR-TB was revealed in all 14 cases investigated by LPA, with KatG MUT profile detected in 85.71%. <b>Conclusions:</b> Until December 2017, almost of half of hospitalized MDR-TB cases had moderate accessibility to a molecular method of rapid diagnosis. LPA had a very good yielding of early detecting MTB strains with concomitant INH and RIF resistance.