Cited by 500Tuberculosis Research and EpidemiologyInfectious Diseases and TuberculosisAntibiotic Resistance in Bacteria

Prediction of Susceptibility to First-Line Tuberculosis Drugs by DNA Sequencing

Open access
The CRyPTIC Consortium and the 100,000 Genomes Project·2018·New England Journal of Medicine

Abstract

BACKGROUND: The World Health Organization recommends drug-susceptibility testing of Mycobacterium tuberculosis complex for all patients with tuberculosis to guide treatment decisions and improve outcomes. Whether DNA sequencing can be used to accurately predict profiles of susceptibility to first-line antituberculosis drugs has not been clear. METHODS: We obtained whole-genome sequences and associated phenotypes of resistance or susceptibility to the first-line antituberculosis drugs isoniazid, rifampin, ethambutol, and pyrazinamide for isolates from 16 countries across six continents. For each isolate, mutations associated with drug resistance and drug susceptibility were identified across nine genes, and individual phenotypes were predicted unless mutations of unknown association were also present. To identify how whole-genome sequencing might direct first-line drug therapy, complete susceptibility profiles were predicted. These profiles were predicted to be susceptible to all four drugs (i.e., pansusceptible) if they were predicted to be susceptible to isoniazid and to the other drugs or if they contained mutations of unknown association in genes that affect susceptibility to the other drugs. We simulated the way in which the negative predictive value changed with the prevalence of drug resistance. RESULTS: A total of 10,209 isolates were analyzed. The largest proportion of phenotypes was predicted for rifampin (9660 [95.4%] of 10,130) and the smallest was predicted for ethambutol (8794 [89.8%] of 9794). Resistance to isoniazid, rifampin, ethambutol, and pyrazinamide was correctly predicted with 97.1%, 97.5%, 94.6%, and 91.3% sensitivity, respectively, and susceptibility to these drugs was correctly predicted with 99.0%, 98.8%, 93.6%, and 96.8% specificity. Of the 7516 isolates with complete phenotypic drug-susceptibility profiles, 5865 (78.0%) had complete genotypic predictions, among which 5250 profiles (89.5%) were correctly predicted. Among the 4037 phenotypic profiles that were predicted to be pansusceptible, 3952 (97.9%) were correctly predicted. CONCLUSIONS: Genotypic predictions of the susceptibility of M. tuberculosis to first-line drugs were found to be correlated with phenotypic susceptibility to these drugs. (Funded by the Bill and Melinda Gates Foundation and others.).

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1056/nejmoa1800474

Cites

22 of 22 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Studies in other areas of medicine have found lower NPVs of even highly sensitive and specific tests in situations where the pretest probability of a disease is high.

    “Studies in other areas of medicine have also found lower NPVs of even highly sensitive and specific tests in situations where the pretest probability of a disease is high23,26,27.”

    From Diagnosis of Alzheimer's disease using plasma biomarkers adjusted to clinical probability (2024) · cites this paper as [26]

    The Results section (page unavailable) reports that negative predictive value declined as the prevalence of tuberculosis drug resistance increased. The Discussion section (page unavailable) says the assay generally met high sensitivity and specificity targets. The paper does not report studies in other areas of medicine or tests for disease in patients with high pretest probability. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Authors
The CRyPTIC Consortium and the 100, 0. G. P.
Venue
New England Journal of Medicine
Published
2018-10-11
Volume
379
Issue
15
Pages
1403-1415
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
OpenAlex
W2902271181
Cited by
500
References
22
Citations by year
2026: 25 · 2025: 41 · 2024: 58 · 2023: 61 · 2022: 78 · 2021: 65 · 2020: 89 · 2019: 72 · 2018: 9 · 2017: 1
FWCI
44.44
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion, cc-by)
  • PubMed Central (acceptedVersion, cc-by)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • HAL (submittedVersion)
  • DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
  • Florence Research (University of Florence) (submittedVersion)
  • LillOA (Université de Lille (University Of Lille)) (submittedVersion, other-oa)
  • Spiral (Imperial College London) (submittedVersion)
Funders
  • Seventh Framework Programme (278864)
  • European Research Council (638553-TB-ACCELERATE)
  • Wellcome Trust and the Royal Society Sir Henry Dale Fellowships (101237/Z/13/Z, 102541/A/13/Z)
  • National University of Singapore Yong Loo Lin School of Medicine Aspiration Fund (NUHSRO/2014/069/AF-New Idea/04)
  • Ministerio de Economía y Competitividad (SAF2016-77346-R)
  • National Science and Technology Key Program of China (2014ZX10003002)
  • National Basic Research program of China (2014CB744403)
  • Health Services and Delivery Research Programme
  • Bill and Melinda Gates Foundation (OPP1133541)
  • Wellcome Trust (200205/Z/15/Z)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
  • Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
Mycobacterium tuberculosis complex, first-line antituberculosis drugs, isoniazid resistance, rifampicin resistance, ethambutol resistance, pyrazinamide resistance, drug resistance mutations, whole genome sequencing, genotype-phenotype correlation, negative predictive value
MeSH terms
Whole Genome Sequencing, Antitubercular Agents, Ethambutol, Genotype, Humans, Isoniazid, Microbial Sensitivity Tests, Mutation, Mycobacterium tuberculosis, Phenotype, Pyrazinamide, Rifampin, Tuberculosis, Genome, Bacterial, Drug Resistance, Bacterial

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review