Sputum microbiota profiles of patients with rifampicin-resistant tuberculosis during the intensive-phase treatment

The respiratory microbiome plays a crucial role in respiratory health and influences the onset and progression of tuberculosis (TB). However, changes in the respiratory microbiota of patients with rifampicin-resistant TB (RR-TB) during the intensive-phase treatment have not been assessed. This study aimed to investigate the impact of a six-month intensive-phase treatment of second-line anti-TB drugs on the respiratory microbiota of RR-TB patients. Sputum samples were collected from 14 RR-TB patients and 14 healthy controls. Microbiota composition was analyzed using 16S rRNA gene sequencing, and functional predictions were performed to assess metabolic pathway changes. RR-TB patients exhibited significantly lower alpha diversity compared to healthy controls, but no significant changes were observed after six months of treatment. Beta diversity analysis revealed distinct clustering patterns between RR-TB patients and healthy controls, with no significant differences between pre- and post-treatment groups. Functional analysis showed reduced microbial functions related to pyruvate fermentation and amino acid metabolism in RR-TB patients. These findings highlight the specific effects of second-line anti-TB drugs on the respiratory microbiota and suggest potential roles of respiratory ecological imbalance in RR-TB pathogenesis. Future studies could explore microbiome-based diagnostic and therapeutic strategies for RR-TB.