A composite reference standard is needed for bedaquiline antimicrobial susceptibility testing for<i>Mycobacterium tuberculosis</i>complex

Abstract

We echo the latest calls that have been made to increase the capacity for antimicrobial susceptibility testing (AST) for bedaquiline for the Mycobacterium tuberculosis complex [1, 2]. However, we would like to highlight the limitations of using insufficiently standardised or validated phenotypic AST methods and breakpoints as the reference standard for bedaquiline AST. Moreover, we advocate for adoption of a composite reference standard that considers genotypic AST results to minimise false-susceptible results for borderline/low-level resistance mechanisms and avoid confusion during clinical decision-making. A composite reference standard minimises false-susceptible AST results for bedaquiline <https://bit.ly/3wAVvFm>