Data Entry: Please note that the research database will be replaced by UNIverse by the end of October 2023. Please enter your data into the system https://universe-intern.unibas.ch. Thanks
Prisons as ecological drivers of fitness-compensated multidrug-resistant Mycobacterium tuberculosis
Journal
Nat Med
Volume
27
Number
7
Pages
1171-1177
Mesh terms
Antitubercular Agents, pharmacology; Drug Resistance, Multiple, Bacterial, genetics; Humans; Mutation, drug effects; Mycobacterium tuberculosis, pathogenicity; Prisoners; Prisons; Tuberculosis, Multidrug-Resistant, transmission
Abstract
Multidrug-resistant tuberculosis (MDR-TB) accounts for one third of the annual deaths due to antimicrobial resistance1. Drug resistance-conferring mutations frequently cause fitness costs in bacteria2-5. Experimental work indicates that these drug resistance-related fitness costs might be mitigated by compensatory mutations6-10. However, the clinical relevance of compensatory evolution remains poorly understood. Here we show that, in the country of Georgia, during a 6-year nationwide study, 63% of MDR-TB was due to patient-to-patient transmission. Compensatory mutations and patient incarceration were independently associated with transmission. Furthermore, compensatory mutations were overrepresented among isolates from incarcerated individuals that also frequently spilled over into the non-incarcerated population. As a result, up to 31% of MDR-TB in Georgia was directly or indirectly linked to prisons. We conclude that prisons fuel the epidemic of MDR-TB in Georgia by acting as ecological drivers of fitness-compensated strains with high transmission potential.
