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Prisons as ecological drivers of fitness-compensated multidrug-resistant Mycobacterium tuberculosis.


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.

SUBMITTER: Gygli SM 

PROVIDER: S-EPMC9400913 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Multidrug-resistant tuberculosis (MDR-TB) accounts for one third of the annual deaths due to antimicrobial resistance<sup>1</sup>. Drug resistance-conferring mutations frequently cause fitness costs in bacteria<sup>2-5</sup>. Experimental work indicates that these drug resistance-related fitness costs might be mitigated by compensatory mutations<sup>6-10</sup>. However, the clinical relevance of compensatory evolution remains poorly understood. Here we show that, in the country of Georgia, durin  ...[more]

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