ORIGINAL RESEARCH article
Front. Microbiol.
Sec. Antimicrobials, Resistance and Chemotherapy
This article is part of the Research TopicAdvancements in Diversity and Drug Resistance Mechanisms in Mycobacterial DiseasesView all 17 articles
Drug Resistance Profile of Mycobacterium tuberculosis in China: Update to 2024
Provisionally accepted
- 1School of Public Health, Shantou University, Shantou, China
- 2Jinan University School of Basic Medicine and Public Health, Guangzhou, China
- 3Shantou Tuberculosis Prevention and Control Institute, Shantou, China
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Background The situation of drug-resistant tuberculosis in China is serious and complex. Most of the study data are still derived from a national survey of drug-resistant tuberculosis in China conducted in 2007. We aimed to fully characterise the prevalence of Mycobacterium tuberculosis(MTB) in China, and to update the catalogue of drug-resistant mutations with geographic variability. Methods This study analyzed MTB isolates collected from 27 provinces, municipalities, and autonomous regions across China. All strains were analysed for resistance to Isoniazid, Rifampicin, Streptomycin, Ethambutol, Pyrazinamide, and Quinolones based on the results of phenotypic drug sensitivity tests. The spatial and temporal distribution characteristics of drug-resistant strains were assessed based on the geographic origin and collection time of the isolates. The association between mutations and resistance was evaluated using mutation rates, positive predictive values, chi-square/Fisher's exact test p-values, and 95% confidence intervals. Results 55388 MTB strains from 2002-2024 were analysed, and a total of 15078 drug-resistant strains were obtained, including 7848 multidrug-resistant strains. The resistance rates of INH, RFP, SM, EMB, PZA, and QS were 27.67%, 25.33%, 11.55%, 6.19%, 8.63% and 20.63%, respectively. The regional distribution presented the characteristics of the highest number of strains, but a low resistance rate in the eastern and western regions. Low inflection point in 2019 for all drugs except INH resistance rates which continue to increase after 2017. A total of 754 non-synonymous mutations were found, with the highest mutation rates in INH (32.91%), RIF (28.98%), and QS (14.47%). The mutation sites were dominated by katG 315AGC→ACC, rpoB 531TCG→TTG, gyrA 94GAC→GGC, respectively, in addition to 96 new mutations that might be related to drug resistance, such as ahpC 11CCG→CCG, pncA 226ACT→CCT. Combined mutations were dominated by rpoB + rpoB, katG + katG, katG + inhA, and other double mutations were predominant. Conclusions Our analysis demonstrates that drug-resistant tuberculosis remains a serious challenge in China. It is recommended that the newly identified resistance-conferring mutations be capitalized and aligned with the specific epidemiological characteristics of DR-TB in China to facilitate the development of rapid diagnostic technologies.
Keywords: Mycobacterium tuberculosis, Drug Resistance, gene mutation, Molecular Epidemiology, mutation profile
Received: 03 Sep 2025; Accepted: 11 Nov 2025.
Copyright: © 2025 Xu, Liu, Zheng, Lin, Gi and Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Qiaocheng Chang, changqiaocheng2001@163.com
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