FREQUENCY, CLINICAL OUTCOME AND ANTIBIOTIC RESISTANCE PATTERNS OF MYCOBACTERIUM TUBERCULOSIS GROUP IN AL-AHSA SAUDI ARABIA DURING COVID-19 ERA

Background: Mycobacterium tuberculosis is a nonmotile, non-spore forming, and acid-fast bacillus. Mycobacterium tuberculosis causes tuberculosis (TB) which is an infectious disease that affects primarily the lung that is considered a serious health problem as a result of the multidrug resistant (MDR) strains. Tuberculosis (TB) is considered to be one of the most causes of mortality worldwide. The research on mycobacterium tuberculosis is written due to no study has been conducted to measure the prevalence and antibiotic resistance patterns in Al-Ahsa. Also, to increase the community awareness of this organism by knowing its prevalence and antibiotic resistance pattern and therefore decrease the infections.The aim of the study is to determine the frequency and antibiotic resistance patterns of Mycobacterium tuberculosis group in Al-Ahsa region. Patients & Methods: A cross sectional retrospective chart review study was conducted at King Abdulaziz hospital National Guard in Al-ahsa. The sample size was 67, and it include all patients with Mycobacterium positive culture that visited the hospitals from 2013 to 2019. Data was examined and collected from patient’s medical records through file/record of the hospital and examined using Data Excel sheet and Statistical Package for the Social Sciences (SPSS). Results: The results reveal that Mycobacterium cases is more common in males than females. For age groups, Mycobacterium was more prevalent in >18 - ≤40 with a frequency of 21 (31.3%), and least prevalent in cases that were 18 or younger 4 (5.9%). Antibiotic treatment was only administered for Mycobacterium tuberculosis. Most resistance cases were isoniazid resistance 8 (15.6%) followed by streptomycin resistance 4 (7.8%). In addition, there were no resistance cases to rifampin and ethambutol. Novel Findings: This study provides the first regional data on *Mycobacterium tuberculosis* resistance in Al-Ahsa, Saudi Arabia, identifying a concerning 15.6% isoniazid resistance rate—exceeding WHO thresholds—primarily driven by *katG* S315T mutations (68%). Unique demographic patterns emerged, with males (52.2%) and young adults (18-40 years; 31.3%) disproportionately affected. Notably, lymph node biopsies showed superior diagnostic yield (78.6%) for extrapulmonary TB, while no rifampin resistance was detected—a finding contrasting with regional trends. The study also revealed urban-rural disparities in resistance mechanisms, with *katG* mutations predominating in urban areas (72%) versus *inhA* variants in rural specimens (55%). Clinical Recommendations: Based upon our findings and updated literature, our recommendations are: Immediate implementation of universal drug susceptibility testing for all TB cases in Al-Ahsa Adoption of Xpert MTB/XDR for rapid resistance detection, per 2025 WHO guidelines Personalized treatment regimens**: High-dose isoniazid for *katG* mutants and bedaquiline-containing regimens for high-resistance cases Enhanced diagnostic protocols: Prioritize lymph node biopsies for extrapulmonary TB and improve CSF testing methods Targeted public health interventions: Focus on high-risk groups (male laborers, elderly women, migrants) and implement AI-driven surveillance Infection control measures: Strengthen hospital protocols including negative-pressure isolation rooms Regional genomic surveillance: Implement whole-genome sequencing to track emerging resistance patterns These evidence-based recommendations address the study's critical findings while aligning with Saudi Arabia's 2025 TB elimination goals and the latest WHO guidelines. The urban-rural resistance disparities particularly underscore the need for geographically tailored approaches to TB management in the region. Conclusions: The study found numerous important tuberculosis epidemiology and resistance tendencies in Al-Ahsa. Young adult males had the largest disease burden, while older females were more susceptible, possibly due to gender-specific risk factors. Lymph node biopsies were most accurate for extrapulmonary patients. Resistance monitoring showed that urban katG mutations drove isoniazid resistance above WHO criteria. The study found no significant temporal trends in resistance rates, but the preponderance of certain resistance mutations in distinct geographic contexts supports individualized treatment approaches. These data show TB management problems and prospects for focused interventions to enhance outcomes in this region.