Mycobacterium tuberculosis Next-Generation Whole Genome Sequencing: Opportunities and Challenges.
Mycobacterium tuberculosis Next-Generation Whole Genome Sequencing: Opportunities and Challenges.
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DOI：
10.1155/2018/1298542
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发表时间：
2018-01-01
影响因子：
--
通讯作者：
de Oliveira, Tulio
中科院分区：
文献类型：
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作者：
Iketleng, Thato;Lessells, Richard;de Oliveira, Tulio
结核分枝杆菌耐药性对全球结核病控制构成威胁。全面和及时的药敏测定对耐药结核病的适当治疗至关重要。表型药敏试验（DST）是结核分枝杆菌耐药测定的金标准。结核分枝杆菌全基因组测序（WGS）有潜力成为综合DST和流行病学调查的一站式方法。在这篇综述中，我们讨论了下一代WGS在了解结核病的分子流行病学和耐药机制方面提供的巨大机会。本文还讨论了DST在患者管理和传播链追踪方面的潜在临床价值和公共卫生影响，以便及时进行公共卫生干预。我们提出了目前在低收入和中等收入环境中实施WGS面临的挑战。在英国等低负担高收入环境中，WGS分析已被实验室常规采用，为患者管理和公共卫生干预提供信息。我们预测，在对流行病影响最大的高负担环境中，这项技术将得到类似的调整。
Mycobacterium tuberculosis drug resistance is a threat to global tuberculosis (TB) control. Comprehensive and timely drug susceptibility determination is critical to inform appropriate treatment of drug-resistant tuberculosis (DR-TB). Phenotypic drug susceptibility testing (DST) is the gold standard for M. tuberculosis drug resistance determination. M. tuberculosis whole genome sequencing (WGS) has the potential to be a one-stop method for both comprehensive DST and epidemiological investigations. We discuss in this review the tremendous opportunities that next-generation WGS presents in terms of understanding the molecular epidemiology of tuberculosis and mechanisms of drug resistance. The potential clinical value and public health impact in the areas of DST for patient management and tracing of transmission chains for timely public health intervention are also discussed. We present the current challenges for the implementation of WGS in low and middle-income settings. WGS analysis has already been adapted routinely in laboratories to inform patient management and public health interventions in low burden high-income settings such as the United Kingdom. We predict that the technology will be adapted similarly in high burden settings where the impact on the epidemic will be greatest.