Emergence of non-categorised Drug-resistant Tuberculosis among non-HIV patients: A new threat to Antimicrobial Resistance in Iraq

Objective: Tuberculosis is one of the ancient infectious diseases that causes a significant rate of death worldwide. Drug-resistant Mycobacterium tuberculosis has been categorised into different categories according to its resistance type. Emergence of new noncategorized strains in the post-COVID-19 years among non-HIV-infected patients forms a new threat to public health in Iraq and limits therapeutic options. The aim is to investigate the effect of the COVID-19 pandemic and HIV infection on tuberculosis incidence and drug resistance category of Mycobacterium tuberculosis in association with age and sex as a risk factor. Methods: A total of 1211 patients were clinically and microbiologically confirmed to have tuberculosis. Identification used sputum smears, culture, Gene-Xpert assay, and drug sensitivity testing using Gene-Xpert MTB/RIF assay. All confirmed cases were checked for HIV. Results: A total of 1211 confirmed TB patients were included. Patients' sex significantly affected the site of infection; pulmonary tuberculosis was 1.22 times higher among males. In contrast, extrapulmonary tuberculosis was significantly higher among females (58.46%). Isolates of the period 2023-2024 showed the emergence of strains sensitive to rifampin and isoniazid but resistant to the second-line anti-TB drugs (13, 30.8%); such resistance is rare and not categorised yet. Age, COVID-19, and HIV infection were not identified as independent predictors for the incidence of tuberculosis. Conclusion: The emergence of a new category of M. tuberculosis among non-HIV-infected patients is an alarming sign. A national screening in all Iraqi cities and health education are recommended to increase public awareness and encourage rational use of antibiotics.