{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:36:23Z","timestamp":1779291383010,"version":"3.51.4"},"reference-count":30,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2017\/16082\u20137"],"award-info":[{"award-number":["2017\/16082\u20137"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["2020\/12585-7"],"award-info":[{"award-number":["2020\/12585-7"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Drug-resistant tuberculosis (DR-TB) threatens global TB control. We investigated the prevalence and molecular characteristics of second-line drug resistance among rifampicin (RIF)- and\/or isoniazid (INH)-resistant Mycobacterium tuberculosis complex (MTBC) isolates in S\u00e3o Paulo, Brazil, using the MTBDRsl v. 2.0 line-probe assay. MTBC isolates RIF- and\/or INH-resistant by GenoType MTBDRplus or phenotypic testing (2019\u20132021) were subsequently tested by MTBDRsl for fluoroquinolone (FQ) and injectable drugs (capreomycin, amikacin, kanamycin) resistance. Isolates with inferred mutations underwent Sanger sequencing. Of 13,557 isolates, 728 (5.4%) were RIF- and\/or INH-resistant (297 INH-R, 235 RIF-R, 196 MDR). Among them, 623 (85.6%) were tested by MTBDRsl; 582 (93.4%) showed no additional resistance, while 41 (6.6%) carried mutations. FQ resistance was detected in 38 isolates (92.7%), mostly in gyrA (n = 35). Three isolates with gyrB mutations were wild-type by sequencing. Two MDR isolates harbored the rrs a1401g mutation, and one also harbored gyrA D94G. Sequencing confirmed resistance in 38 of 41 isolates. Most MDR strains with second-line mutations (n = 32\/33; 97%) were pre-XDR. Affected patients were predominantly male (68.4%), with pulmonary TB (92.1%), and unfavorable outcomes (39.5%). Second-line resistance prevalence was low overall, but FQ resistance was high among MDR isolates. Findings support integrating molecular and sequencing-based tools for accurate detection and management of DR-TB.<\/jats:p>","DOI":"10.3390\/microorganisms13112470","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T17:38:22Z","timestamp":1761759502000},"page":"2470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fluoroquinolone and Second-Line Injectable Resistance Among Rifampicin- and Isoniazid-Resistant Mycobacterium tuberculosis Clinical Isolates: A Molecular Study from a High-Burden Setting"],"prefix":"10.3390","volume":"13","author":[{"given":"Ros\u00e2ngela Siqueira","family":"Oliveira","sequence":"first","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6036-9139","authenticated-orcid":false,"given":"Angela Pires","family":"Brandao","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"},{"name":"Instituto Oswaldo Cruz, Funda\u00e7\u00e3o Oswaldo Cruz (FIOCRUZ), Rio de Janeiro 21040-360, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8632-3736","authenticated-orcid":false,"given":"Fabiane Maria de Almeida","family":"Ferreira","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sonia Maria da","family":"Costa","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vera Lucia Maria","family":"Silva","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucilaine","family":"Ferrazoli","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica","family":"Chimara","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5758-6688","authenticated-orcid":false,"given":"Juliana Maira Watanabe","family":"Pinhata","sequence":"additional","affiliation":[{"name":"N\u00facleo de Tuberculose e Micobacterioses, Centro de Bacteriologia, Instituto Adolfo Lutz (IAL), S\u00e3o Paulo 01246-000, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (WHO) (2025, September 25). 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