A composite reference standard is needed for bedaquiline antimicrobial susceptibility testing for<i>Mycobacterium tuberculosis</i>complex
Claudio U. Köser, Paolo Miotto, Nabila Ismail, Richard Anthony, Christian Utpatel, Matthias Merker, Stefan Niemann, Sabira Tahseen, Leen Rigouts, Camilla Rodrigues, Shaheed Vally Omar, Maha Farhat, Uladzimir Antonenka, Harald Hoffmann, Daniela María Cirillo, Thomas Schön
Abstract
We echo the latest calls that have been made to increase the capacity for antimicrobial susceptibility testing (AST) for bedaquiline for the Mycobacterium tuberculosis complex [1, 2]. However, we would like to highlight the limitations of using insufficiently standardised or validated phenotypic AST methods and breakpoints as the reference standard for bedaquiline AST. Moreover, we advocate for adoption of a composite reference standard that considers genotypic AST results to minimise false-susceptible results for borderline/low-level resistance mechanisms and avoid confusion during clinical decision-making. A composite reference standard minimises false-susceptible AST results for bedaquiline <https://bit.ly/3wAVvFm>