{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T02:48:29Z","timestamp":1792896509067,"version":"4.5.0"},"reference-count":51,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["NRF-2023R1A2C1005947"],"award-info":[{"award-number":["NRF-2023R1A2C1005947"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Multidrug-resistant tuberculosis is a major global health concern. Newer agents, including bedaquiline (BDQ), delamanid (DLM), pretomanid (PMD), and linezolid (LZD), are essential for treatment; however, the resistance mechanisms of these drugs remain poorly understood in South Korea. This study aimed to investigate correlations between phenotypic and genotypic resistance to these drugs using 49 clinical Mycobacterium tuberculosis isolates collected in South Korea between 2017 and 2022. The minimum inhibitory concentrations were determined using the 7H9 broth microdilution method, and whole-genome sequencing (WGS) results were compared with the May 2024 World Health Organization (WHO) mutation catalogue. Phenotypic drug susceptibility testing (pDST) revealed elevated MICs to BDQ in 12 isolates (24.5%), DLM in nine (18.4%), and PMD and LZD in two each (4.1%). No Group 1 or 2 resistance-associated mutations were detected in BDQ-, PMD-, or LZD-elevated-MIC isolates. A Group 2 mutation (fbiC_LoF) was observed in one DLM-elevated-MIC isolate, whereas fbiC_p.Ala855fs (WHO Group 2) mutations occurred in four susceptible isolates. These findings suggest resistance mechanisms beyond the current WHO catalog. Discrepancies between pDST and WGS highlight the need for integrated diagnostics and reinforce the importance of ongoing surveillance and refinement of mutation classification systems to improve genotypic resistance prediction.<\/jats:p>","DOI":"10.3390\/pathogens15030320","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T09:35:57Z","timestamp":1773740157000},"page":"320","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Whole-Genome Sequencing and Phenotypic Drug Susceptibility Testing of Bedaquilin, Delamanid, Pretomanid, and Linezolid in Drug-Resistant Mycobacterium tuberculosis from a Single Institute in South Korea"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9438-1603","authenticated-orcid":false,"given":"Hyun-Woo","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju 61496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0577-3305","authenticated-orcid":false,"given":"Yoo-Ree","family":"Kang","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, SD Medical Research Institute, Yongin 17013, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1732-1938","authenticated-orcid":false,"given":"Eun-Soon","family":"Son","sequence":"additional","affiliation":[{"name":"Microbiology Research Section, International Tuberculosis Research Center, Changwon 51755, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7493-1996","authenticated-orcid":false,"given":"Kyungsik","family":"Choi","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, Korea National Tuberculosis Association, Seoul 06763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8989-1430","authenticated-orcid":false,"given":"Myungsun","family":"Cho","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, Korea National Tuberculosis Association, Seoul 06763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8182-2433","authenticated-orcid":false,"given":"Young Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seo A","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Graduate School of Chonnam National University, Gwangju 61186, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7496-6111","authenticated-orcid":false,"given":"Jin Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, SD Medical Research Institute, Yongin 17013, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1048-3745","authenticated-orcid":false,"given":"Jee Hey","family":"Kim","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, SD Medical Research Institute, Yongin 17013, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2391-2121","authenticated-orcid":false,"given":"Seon Joo","family":"Kang","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, SD Medical Research Institute, Yongin 17013, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9708-5837","authenticated-orcid":false,"given":"Seung-Jung","family":"Kee","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine, Chonnam National University Medical School and Hospital, Gwangju 61496, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4340-9856","authenticated-orcid":false,"given":"Jong Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Microbiology Research Section, International Tuberculosis Research Center, Changwon 51755, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8117-5512","authenticated-orcid":false,"given":"Hee Joo","family":"Lee","sequence":"additional","affiliation":[{"name":"Laboratory Medicine Center, SD Medical Research Institute, Yongin 17013, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2026, February 24). 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