Whole genome sequencing in clinical isolates from tuberculosis patients in India; real world data indicates a high proportion of pre-XDR cases

The current study is real world data on the TB drug resistance profile by whole-genome sequencingfrom 600 clinical samples across varied geographical regions from India. This study indicates theclinician's primary reasons for sending samples for WGS; which is for difficult to treat cases and/orrelapse and treatment failure. The study reports a significant proportion of cases with pre-XDR-TBstrains that warrant policy makers' attention. It reflects the current iterative nature of the diagnostic testsunder programmatic conditions that leads to delays in appropriate diagnosis and empirical treatment.Timely implementation of TB-WGS on a wider scale can overcome the current diagnostic barriers.This study adds significant body of data on the mutation profiles seen in Indian population, mutationsoutside the RRDR (rifampicin resistance determining region) and disputed mutations (8 and 34 casesrespectively); and resistance to newer drugs such as Bedaquiline, and Linezolid (in 6 and 45 casesrespectively).