{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T21:44:50Z","timestamp":1765143890351,"version":"3.40.5"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T00:00:00Z","timestamp":1714953600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Multidrug-resistant tuberculosis (MDR-TB), characterized by isoniazid and rifampicin resistance, is caused by chromosomal mutations that restrict treatment options and complicate tuberculosis management. This study sought to investigate the prevalence of pre-extensively drug-resistant (pre-XDR) and extensively drug-resistant (XDR) tuberculosis, as well as mutation pattern, in Nepalese patients with MDR\/rifampicin-resistant (RR)-TB strains.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cross-sectional study was conducted on MDR\/RR-TB patients at the German Nepal Tuberculosis Project from June 2017 to June 2018. The MTBDRsl line probe assay identified pre-XDR-TB and XDR-TB. Pre-XDR-TB included MDR\/RR-TB with resistance to any fluoroquinolone (FLQ), while XDR-TB included MDR\/RR-TB with resistance to any FLQ and at least one additional group A drug. Mutation status was determined by comparing bands on reaction zones [<jats:italic>gyrA<\/jats:italic> and <jats:italic>gyrB<\/jats:italic> for FLQ resistance, <jats:italic>rrs<\/jats:italic> for SILD resistance, and <jats:italic>eis<\/jats:italic> for low-level kanamycin resistance, according to the GenoType MTBDRsl VER 2.0, Hain Lifescience GmbH, Nehren, Germany definition of pre-XDR and XDR] to the evaluation sheet. SPSS version 17.0 was used for data analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Out of a total of 171 patients with MDR\/RR-TB, 160 had (93.57%) had MTBC, of whom 57 (35.63%) had pre-XDR-TB and 10 (6.25%) had XDR-TB. Among the pre-XDR-TB strains, 56 (98.25%) were FLQ resistant, while 1 (1.75%) was SLID resistant. The most frequent mutations were found at codons MUT3C (57.14%, 32\/56) and MUT1 (23.21%, 13\/56) of the <jats:italic>gyrA<\/jats:italic> gene. One patient had SLID resistant genotype at the MUT1 codon of the <jats:italic>rrs<\/jats:italic> gene (100%, 1\/1). XDR-TB mutation bands were mostly detected on MUT1 (30%, 3\/10) of the <jats:italic>gyrA<\/jats:italic> and <jats:italic>rrs<\/jats:italic>, MUT3C (30%, 3\/10) of the <jats:italic>gyrA<\/jats:italic>, and MUT1 (30%, 3\/10) of the <jats:italic>rrs<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Pre-XDR-TB had a significantly higher likelihood than XDR-TB, with different specific mutation bands present in <jats:italic>gyrA<\/jats:italic> and <jats:italic>rrs<\/jats:italic> genes.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301210","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T17:31:43Z","timestamp":1715016703000},"page":"e0301210","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Drug-resistant Mycobacterium tuberculosis among Nepalese patients at a tuberculosis referral center"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3021-2886","authenticated-orcid":true,"given":"Arun Bahadur","family":"Chand","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajaya","family":"Basnet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhagwan","family":"Maharjan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ganesh","family":"Rai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yadav Prasad","family":"Joshi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lok Raj","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bindu","family":"Sen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiba Kumar","family":"Rai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,5,6]]},"reference":[{"key":"pone.0301210.ref001","unstructured":"World Health Organization. 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