Doyle, RM;
Burgess, C;
Williams, R;
Gorton, R;
Booth, H;
Brown, J;
Bryant, JM;
... Breuer, J; + view all
(2018)
Direct whole genome sequencing of sputum accurately identifies drug resistant Mycobacterium tuberculosis faster than MGIT culture sequencing.
Journal of Clinical Microbiology
10.1128/JCM.00666-18.
(In press).
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Abstract
The current methods available to diagnose antimicrobial resistant Mycobacterium tuberculosis infections require positive culture or only test a limited number of resistance-associated mutations. Rapid, accurate identification of antimicrobial resistance enables prompt initiation of effective treatment. Here, we determine the utility of whole-genome sequencing (WGS) M. tuberculosis directly from routinely obtained diagnostic sputum samples to provide a comprehensive resistance profile compared to Mycobacterial Growth Indicator Tube (MGIT) WGS. We sequenced M. tuberculosis from 43 sputum samples by targeted DNA enrichment using the Agilent SureSelectXT kit, and 43 MGIT positive samples from each participant. Thirty two (74%) sputum samples and 43 (100%) MGIT samples generated whole genomes. Time to antimicrobial resistance profile and concordance was compared with Xpert MTB/RIF and phenotypic resistance testing from culture of the same samples. Antibiotic susceptibility could be predicted from WGS of sputum within 5 days of sample receipt and up to 24 days earlier than WGS from MGIT culture and up to 31 days earlier than phenotypic testing. Direct sputum results could be reduced to 3 days with faster hybridisation and if only regions encoding drug resistance are sequenced. We show that direct sputum sequencing has the potential to provide comprehensive resistance detection significantly faster than MGIT whole genome sequencing or phenotypic testing of resistance from culture in a clinical setting. This improved turnaround time enables prompt, appropriate treatment with associated patient and health service benefit. Improvements in sample preparation are necessary to ensure comparable sensitivity and complete resistance profile predictions in all cases.
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