{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:59:57Z","timestamp":1783799997059,"version":"3.55.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Investigating the molecular epidemiological characteristics of multidrug-resistant tuberculosis (MDR-TB) in China\u2019s moderate-burden regions, such as Wuhan, is crucial for understanding and controlling disease transmission.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>This study analyzed MDR-TB isolates from pulmonary tuberculosis cases registered at Wuhan Pulmonary Hospital in 2017. Whole genome sequencing (WGS) was used to identify resistance-conferring mutations, examine their associations with specific <jats:italic>Mycobacterium tuberculosis<\/jats:italic> lineages or sublineages, and assess clustering profiles.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among the 149 analyzed strains, the most prevalent mutations associated with resistance to 11 anti-tuberculosis drugs were identified as follows: <jats:italic>rpoB<\/jats:italic> Ser450Leu (59.73%, rifampicin), katG Ser315Thr (62.42%, isoniazid), embB Met306Val (42.86%, ethambutol), rpsL Lys43Arg (68.13%, streptomycin), pncA Trp68Arg (10.53%, pyrazinamide), gyrA Asp94Gly (22.50%, fluoroquinolones), and rrs 1401A\u202f&amp;gt;\u202fG (50.00\u2013100.00%, second-line injectable aminoglycosides). Additional mutations were detected in fabG1 c-15C\u202f&amp;gt;\u202fT (42.86%, ethionamide) and thyX c-16C\u202f&amp;gt;\u202fT (21.43%, p-aminosalicylic acid). Notably, rare mutations absent from the WHO mutation catalog, such as ahpC c-52C\u202f&amp;gt;\u202fT and rpsL Lys43Thr, were also observed. The mutation frequency of <jats:italic>embB<\/jats:italic> Met306Ile was significantly higher in Lineage 4 (L4) strains than in Lineage 2 (L2) strains (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0150), while the rpsL Lys43Arg mutation frequency was lower in L4 compared to L2 (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0333). A total of 31 MDR MTB <jats:italic>Mycobacterium tuberculosis<\/jats:italic> isolates formed clusters, resulting in a clustering rate of 20.81% and a recent transmission rate of 11.41%. The clustering rates between L4 and L2 strains were not significantly different (\u03c7<jats:sup>2<\/jats:sup>\u202f=\u202f0.0017, <jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The genetic diversity of MDR-TB in Wuhan demonstrates unique characteristics, with evidence of localized transmission. These findings highlight the urgent need to strengthen measures to detect early cases of MDR-TB and control transmission of MDR-TB in the region.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1442987","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T06:42:55Z","timestamp":1738046575000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Genetic diversity and transmission pattern of multidrug-resistant tuberculosis based on whole-genome sequencing in Wuhan, 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