Molecular Profile of Rifampicin and Isoniazid Resistance in the Mycobacterium tuberculosis Complex at Paul VI Hospital in Ouagadougou: A Study Based on GeneXpert MTB/RIF Ultra and MTB/XDR Tests
Introduction: Tuberculosis (TB) remains a major public health problem, particularly in Burkina Faso. The emergence of strains resistant to rifampin (RIF) and isoniazid (INH) compromises the effectiveness of standard treatments. This study aimed to describe the molecular profile of rifampicin and isoniazid resistance in Mycobacterium tuberculosis complex among patients treated at Paul VI Hospital in Ouagadougou, based on results obtained from the Xpert MTB/RIF Ultra and Xpert MTB/XDR tests. Methods: This was a descriptive cross-sectional study conducted from January 2023 to December 2024. Sputum samples were analyzed by microscopy and by GeneXpert MTB/RIF and MTB/XDR to detect the Mycobacterium tuberculosis complex and resistance mutations. Results: Of the 4,358 patients included, the mean age was 40.80 ± 17.73 years, with a significant predominance of males (66.82%; male-to-female ratio = 2; p < 0.001). The prevalence of PCR-confirmed TB was 20.72% (903/4,358). A comparative analysis between microscopy and TB-PCR yielded very similar positivity rates (20.58% vs. 20.72%). The overall molecular resistance to RIF was 1.44% (13/903). Molecular resistance to INH was 0.44% (4/903). A significant association was observed between treatment nonadherence and resistance to RIF (p = 0.021). No cases of multidrug resistance (RIF + INH) were detected among patients who relapsed, failed treatment, or resumed treatment. The Xpert tests used detect the presence of resistance but do not identify the specific mutation responsible. Conclusion: The prevalence of drug-resistant tuberculosis remains low in our cohort. Rifampicin resistance is significantly associated with nonadherence. Continuous molecular surveillance is necessary to detect the emergence of resistant strains early and to adapt treatment strategies. However, precise identification of mutations (S531L for RIF, katG or inhA for INH) could not be performed using GeneXpert tests, which do not provide the mutational profile. Characterization by sequencing would be necessary to determine the distribution of circulating mutations in Burkina Faso.
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