Extensive Endemic Transmission of Multidrug-Resistant Mycobacterium tuberculosis in Bhutan: A Retrospective Genomic-Epidemiological Study

Abstract

Background The proportion of multidrug-resistant tuberculosis (MDR-TB) cases is increasing in Bhutan. We conducted the first retrospective genomic-epidemiological study to provide insights into the population structure, resistance patterns, and recent transmission in Bhutan. Methods Whole genome sequencing was performed on randomly selected drug-resistant (DR-TB) and drug-sensitive TB (DS-TB) isolates from Bhutan, collected between 2018 and 2022 at the Microbiological Diagnostic Unit Public Health Laboratory in Melbourne, Australia. Bioinformatic analysis was performed to identify drug-resistance mutations and genomic clustering of cases. Results Approximately 40% of DR-TB and 2.5% of DS-TB ..