Routine Xpert MTB/XDR for Tuberculosis Drug-Resistance Surveillance in Northern Morocco: A Four-Year Programmatic Analysis
- 1Universite Abdelmalek Essaadi Faculte des Sciences
Abstract
Drug-resistant tuberculosis surveillance requires diagnostic systems that can rapidly identify resistance beyond rifampicin and generate potentially actionable resistance information for routine public-health monitoring. We evaluated programmatic Xpert MTB/XDR use and characterized the molecular resistance profiles generated within a regional tuberculosis diagnostic network in northern Morocco. We retrospectively analyzed 258 Xpert MTB/XDR testing episodes performed from April 2022 to July 2026 and linked available Xpert MTB/RIF Ultra results with target-level molecular outputs. Mycobacterium tuberculosis complex was detected in 203 episodes (78.7%), of which 188 (92.6%) had an interpretable rifampicin result. Molecular rifampicin resistance was detected in 75/188 episodes (39.9%) and isoniazid resistance in 71/192 (37.0%); molecular multidrug-resistant tuberculosis was identified in 51/184 (27.7%) episodes with paired results. Among 186 episodes with interpretable rifampicin and additional resistance results, 75 (40.3%) had resistance to at least one additional drug class, including 21/112 (18.8%) rifampicin-susceptible and 54/74 (73.0%) rifampicin-resistant episodes. Among 92 resistant episodes with complete profiles, 66 (71.7%) showed resistance to two or more drug classes. rpoB3- and rpoB4-associated signals predominated among rifampicin-resistant episodes, katG-associated signals among isoniazid-resistant episodes, and gyrA targets among fluoroquinolone-resistant episodes. Mixed wild-type and mutation-associated signals occurred across rpoB and gyrA. These findings support the use of routine Xpert MTB/XDR testing as a component of regional drug-resistant tuberculosis surveillance, enabling systematic characterization of multiclass resistance and molecular resistance patterns within routine diagnostic networks. Such molecular surveillance should be integrated with phenotypic susceptibility testing and genomic sequencing to resolve discordant, atypical, or clinically consequential profiles and build a more comprehensive regional resistance-monitoring system.
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BibTeX
@misc{ezzari2026routine,
title = {{Routine Xpert MTB/XDR for Tuberculosis Drug-Resistance Surveillance in Northern Morocco: A Four-Year Programmatic Analysis}},
author = {A. Ez-Zari and A. Boulaich and K. Bouti and Z. Mennane and N. Elmtili and N. Mezzoug},
howpublished = {medRxiv},
year = {2026},
month = nov,
doi = {10.64898/2026.11.05.26364787},
url = {https://www.medrxiv.org/content/10.64898/2026.11.05.26364787v1},
note = {CC BY-NC},
}
RIS
TY - UNPB
TI - Routine Xpert MTB/XDR for Tuberculosis Drug-Resistance Surveillance in Northern Morocco: A Four-Year Programmatic Analysis
AU - A. Ez-Zari
AU - A. Boulaich
AU - K. Bouti
AU - Z. Mennane
AU - N. Elmtili
AU - N. Mezzoug
PY - 2026
DA - 2026/11/05
PB - medRxiv
DO - 10.64898/2026.11.05.26364787
UR - https://www.medrxiv.org/content/10.64898/2026.11.05.26364787v1
AB - Drug-resistant tuberculosis surveillance requires diagnostic systems that can rapidly identify resistance beyond rifampicin and generate potentially actionable resistance information for routine public-health monitoring. We evaluated programmatic Xpert MTB/XDR use and characterized the molecular resistance profiles generated within a regional tuberculosis diagnostic network in northern Morocco. We retrospectively analyzed 258 Xpert MTB/XDR testing episodes performed from April 2022 to July 2026 and linked available Xpert MTB/RIF Ultra results with target-level molecular outputs. Mycobacterium tuberculosis complex was detected in 203 episodes (78.7%), of which 188 (92.6%) had an interpretable rifampicin result. Molecular rifampicin resistance was detected in 75/188 episodes (39.9%) and isoniazid resistance in 71/192 (37.0%); molecular multidrug-resistant tuberculosis was identified in 51/184 (27.7%) episodes with paired results. Among 186 episodes with interpretable rifampicin and additional resistance results, 75 (40.3%) had resistance to at least one additional drug class, including 21/112 (18.8%) rifampicin-susceptible and 54/74 (73.0%) rifampicin-resistant episodes. Among 92 resistant episodes with complete profiles, 66 (71.7%) showed resistance to two or more drug classes. rpoB3- and rpoB4-associated signals predominated among rifampicin-resistant episodes, katG-associated signals among isoniazid-resistant episodes, and gyrA targets among fluoroquinolone-resistant episodes. Mixed wild-type and mutation-associated signals occurred across rpoB and gyrA. These findings support the use of routine Xpert MTB/XDR testing as a component of regional drug-resistant tuberculosis surveillance, enabling systematic characterization of multiclass resistance and molecular resistance patterns within routine diagnostic networks. Such molecular surveillance should be integrated with phenotypic susceptibility testing and genomic sequencing to resolve discordant, atypical, or clinically consequential profiles and build a more comprehensive regional resistance-monitoring system.
ER -