Rising Bedaquiline Resistance: A New Challenge in Drug-Resistant TB

Bedaquiline resistance is increasingly seen in the treatment of rifampicin-resistant tuberculosis (TB), yet there are no standardized regimens for managing it. Research shows that a significant number of bedaquiline-resistant cases have a history of TB treatment and often involve quinolone-resistant strains. Regular culture monitoring in patients undergoing treatment for bedaquiline resistance is recommended. Techniques such as experimental evolution, protein modeling, genome sequencing, and phenotypic analysis have been key in identifying the mechanisms of this resistance. Notably, variants in the Rv0678 transcriptional repressor of the MmpS5-MmpL5 efflux system are associated with bedaquiline resistance. Bayesian probability estimates show potential in linking genotypic and phenotypic data, offering promise for clinical use. Future studies should investigate the application of Bayesian probabilities in managing bedaquiline resistance, with sequencing-based technologies expected to play a crucial role in the early detection and management of drug-resistant TB strains.

Satapathy, P., Itumalla, R., Neyazi, A., Taraki, A.M.N., Khatib, M.N., Gaidhane, S., Zahiruddin, Q.S., Rustagi, S. and Neyazi, M., 2024. Emerging bedaquiline resistance: A threat to the global fight against drug-resistant tuberculosis. Journal of Biosafety and Biosecurity, 6(1), pp.13-15.