Phenotypic and genotypic characterization of pyrazinamide resistance-India, 2018-2020.

Pyrazinamide (PZA) is a key first-line antituberculosis drug that plays an important role in eradicating persister (TB) bacilli and shortening the duration of tuberculosis treatment. However, PZA-resistance is on the rise, particularly among persons with multidrug-resistant (MDR) tuberculosis. This nationwide study was conducted to explore the prevalence of mutations conferring PZA resistance, catalogue mutation diversity, investigate the associations of PZA resistance with specific lineages, examine co-resistance to 13 first- and second-line drugs, and evaluate the diagnostic accuracy of sequencing A and D genes for predicting PZA resistance.