Development of multidrug-resistant in the biofilm of a peritoneal-venous shunt.

A patient with ascites received a peritoneal-venous shunt for presumed cirrhosis, however surgical specimens grew (MTb) sensitive to all anti-tuberculous drugs. Directly-Observed-Therapy (DOT) led to improvement followed by relapse with multidrug resistant MTb (MDRTB). We discuss pathways for selection of MDRTB within mycobacterial biofilm.