Decoding moxifloxacin resistance in pre-XDR tuberculosis using MGIT 960 and MYCOTB AST.
Abstract
Background and objectives: Treatment of moxifloxacin-resistant tuberculosis is complicated by heteroresistance, high resistance prevalence, genotype-phenotype discordance, pharmacokinetic antagonism, and the need for individualised regimen design. Reliable minimum inhibitory concentration (MIC)-based drug susceptibility testing (DST) is therefore essential for optimised therapy. This study aimed to compare moxifloxacin MICs in pre-extensively drug-resistant tuberculosis isolates using the BACTEC MGIT 960 as the reference method and Sensititre MYCOTB AST plate as the index test.
Methods: The prospective laboratory-based comparative study collected leftover routine patient samples, processed them for culture, and retrieved the isolates from BACTEC MGIT tubes that showed second-line drug resistance by line probe assay (LPA), and subsequently included them at the tertiary care centre in central India from July 2025 to February 2026. Non-tuberculous mycobacteria and samples with insufficient information were neglected. Eligible isolates were tested using MGIT 960 and Sensititre MYCOTB AST with blinded interpretation. Diagnostic accuracy and agreement were assessed.
Results: Among 9369 samples screened,30 pre-XDR tuberculosis isolates met the inclusion criteria. For moxifloxacin DST, Sensititre MYCOTB AST demonstrated 100% sensitivity, 66.7% specificity, 96.75% overall accuracy, and substantial agreement with MGIT 960 (Cohen's kappa 0.783). The index test also provided…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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