Publication date: Jun 18, 2025
Long-term transmission of multidrug-resistant tuberculosis (MDR-TB) challenges TB control by generating new cases and enabling the emergence of extensively resistant strains. We investigated its epidemiologic and bacterial drivers in Shanghai, China. We conducted a retrospective study of M. tuberculosis isolates and associated epidemiological data from individuals diagnosed with rifampicin-resistant TB in Shanghai over 14 years (2004-2018). Using whole-genome sequencing, Bayesian reconstruction of transmission trees, and multivariable regression analysis to identify epidemiological and bacterial factors associated with the transmission of MDR-TB. Between 2004 and 2018, 1,456 individuals in Shanghai were diagnosed with MDR or rifampicin-resistant TB, with whole-genome sequences available for 1,100 isolates. The overall genomic clustering rate was 55. 3%, with large clusters (those containing ≥5 cases) accounting for 39. 9% of the clustered strains. Risk factors for clustered MDR-TB transmission included local residency (aOR 2. 28, 95% CI 1. 67-3. 11), diagnostic delays ≥2 months (aOR 1. 75, 95% CI 1. 24-2. 47), specific M. tuberculosis sublineages (L2. 3.3-L2. 3.6), and the rpoB S450L mutation with compensatory mutations (aOR 2. 14, 95% CI 1. 64-2. 78). Large MDR-TB clusters were significantly associated with long-term transmission (>5 years, p
| Concepts | Keywords |
|---|---|
| Bacterial | Compensatory mutations |
| Epidemiologic | Long-term transmission |
| Shanghai | Multidrug-resistant tuberculosis |
| Whole-genome sequencing |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | Multidrug-Resistant Tuberculosis |
| disease | MESH | tuberculosis |
| pathway | KEGG | Tuberculosis |
| drug | DRUGBANK | Rifampicin |