Antimicrobial resistance in leprosy: results of the first prospective open survey conducted by a WHO surveillance network for the period 2009–15
Authors: E. Cambau, P. Saunderson, M. Matsuoka, S.T. Cole, M. Kai, P. Suffys, P.S. Rosa, D. Williams, U.D. Gupta, M. Lavania, N. Cardona-Castro, Y. Miyamoto, D. Hagge, A. Srikantam, W. Hongseng, A. Indropo, V. Vissa, R.C. Johnson, B. Cauchoix, V.K. Pannikar, E.A.W.D. Cooreman, V.R.R. Pemmaraju, L. Gillini, A. Kriswamati, Abdul Rahim Al-Samie, Ahamed Issoufou, Alexandre Tiendrebeogo, AmriMiraju Kingalu, Andriamira Randrianantoandro, Anil Kumar, Aurelie Chauffour, Aye Aye Win, Basudev Pandey, C.M. Agrawal, Christiana Widaningrum, Christine Schmotzer, Christophe Kafando, Chuda Mani Bhandari, Cynthia Sema, D.S. Vidanagama, David M. Scollard, Demmissew Beyene, Eliane Faria Morelo, Elizabeth Dizaneh Kassa, Enerantien Benoit Ramarolahy, Eric Claco, Ernesto ES. Villalon, Famoussa Sidibe, Fatoumata Sakho, Fomba Abdoulaye, Francisco F. Guilengue, Fransesca Gajete, Gadde Rajan Babu, Gado Moussa, Garib Das Thakur, Gemma Cabanos, Gouressi Sock, Greame Clugston, Hany Zaidy, Haruo Watanabe, Herman Joseph Kawuma, Irene Balenton Mallari, Isabella Maria Bernandes Goulart, Issoufou Ahamed, J. Subbanna, Jean Gabin Houzeo, Jean Norbert Mputu Luengu, Jeanne Bertolli, Jonathan Lloyd-Owen, Jorge Matheu, José Pereira Brunelli, Juan Camilo Beltran Alzate, Kapil Dev Neupane, Katsunori Osuga, Kazuko Yamaguchi, Khalid Azam, Khin Maung Lin, Kodia Momoudu, Kyaw Kyaw, Landry Bide, Le Huu Doanh, Ley Huyen My, Mahesh Shah, Mamadou Kodio, Mamadou Sidibe, Mannam Ebenezer, Maria Aparecida de Faria Grossi, Marivic F. Balagon, Marlience Canlonon, Masahiko Makino, Maung Maung Htoo, Md Jamsheed Ahmed, Mintsey-mi-Makuth Nadine, Florenda Orcullo Roferos, Hana Krismawati, Mya Thida, Myo Thet Htoon, K.D. Neupane, Nhu Ha Nguyen Phuc, NguyenThi Hai Van, Ngyuen Phuc Nhu Hai, Norisha Ishii, Oke Soe, Olga Amiel, Omar Tossou, Ousmane Konare, P.L. Joshi, P.V. Ranganadha Rao, Padebettu Krishnamurthy, Patrick J. Brennan, Phillipe Busso, Rajesh Bhatia, Mala Rakoto Andrianarivelo, D.R. Ramdas, Raoul Chabi, Renato Gusmao, Rita DjupuriIzwardy, Rosa Castalia Franca Riberio Soares, Rupendra Jhadav, Samira Buhrer, Sang-Nae Ray Cho, Shen Jianping, Shinzo Lzumi, Sumana Barua, Sundeep Chaitanya, Sylvestre Marie Roget Tiendrebeogo, Tan Hau Khang, Thomas P. Gillis, Toru Mori, V. Vijayalakshmi, Vedastus Deusdedit Kamara, Wang Wei, W.Cairn S. Smith, Wei Li, Woojin Lew, Yasin Al-Qubati, Yasuhiko Suzuki, Yoshio Nanba
Journal: Clinical Microbiology and Infection (2018)

ObjectivesAntimicrobial resistance (AMR) is a priority for surveillance in bacterial infections. For leprosy, AMR has not been assessed because Mycobacterium leprae does not grow in vitro. We aim to obtain AMR data using molecular detection of resistance genes and to conduct a prospective open survey of resistance to antileprosy drugs in countries where leprosy is endemic through a WHO surveillance network.MethodsFrom 2009 to 2015, multi-bacillary leprosy cases at sentinel sites of 19 countries were studied for resistance to rifampicin, dapsone and ofloxacin by PCR sequencing of the drug-resistance-determining regions of the genes rpoB, folP1 and gyrA.ResultsAmong 1932 (1143 relapse and 789 new) cases studied, 154 (8.0%) M. leprae strains were found with mutations conferring resistance showing 182 resistance traits (74 for rifampicin, 87 for dapsone and 21 for ofloxacin). Twenty cases showed rifampicin and dapsone resistance, four showed ofloxacin and dapsone resistance, but no cases were resistant to rifampicin and ofloxacin. Rifampicin resistance was observed among relapse (58/1143, 5.1%) and new (16/789, 2.0%) cases in 12 countries. India, Brazil and Colombia reported more than five rifampicin-resistant cases.ConclusionsThis is the first study reporting global data on AMR in leprosy. Rifampicin resistance emerged, stressing the need for expansion of surveillance. This is also a call for vigilance on the global use of antimicrobial agents, because ofloxacin resistance probably developed in relation to the general intake of antibiotics for other infections as it is not part of the multidrug combination used to treat leprosy.Graphical abstract