• Prabha Desikan, Nikita Panwalkar, Ram Prakash Punde, Zeba Khan, Ankur Pauranik, Shaina Beg Mirza, Manju Chourey, Sridhar Anand, and K S Sachdeva.
• ICMR-Bhopal Memorial Hospital & Research Centre, Bhopal, Madhya Pradesh, India.
• Indian J Med Res. 2023 Feb 1; 157 (2&3): 174182174-182.

Background & ObjectivesA combination of resistant and susceptible Mycobacterium tuberculosis (MTB) isolated from clinical specimens is referred to as heteroresistance. Heteroresistance leads to difficulties in drug resistance testing and may adversely affect treatment outcomes. The present study estimated the proportion of heteroresistance among MTB in clinical samples of presumptive drug-resistant tuberculosis (TB) patients in Central India.MethodsA retrospective analysis of data generated from line probe assay (LPA) at a tertiary care hospital in Central India between January 2013 and December 2018 was carried out. A heteroresistant MTB in a sample was indicated by the presence of both wild-type and mutant-type patterns on an LPA strip.ResultsData analysis was carried out on interpretable 11,788 LPA results. Heteroresistance in MTB was detected in 637 (5.4%) samples. Of these, heteroresistance in MTB was detected in 413 (64.8%), 163 (25.5%) and 61 (9.5%) samples with respect to rpoB, katG and inhA genes, respectively.Interpretation & ConclusionsHeteroresistance is considered a preliminary step in the development of drug resistance. Delayed or suboptimal anti-tubercular therapy in patients with heteroresistance of MTB may elicit full clinical resistance and negatively impact the National TB Elimination Programme. Further studies are, however, needed to determine the impact of heteroresistance on treatment outcomes in individual patients.

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