Publication date: May 06, 2025

It is well-established that direct drug susceptibility testing (DST) of Mycobacterium tuberculosis using a liquid medium for first-line drugs provides accurate and time-saving results. The purpose of this study was to determine whether DST for second-line drugs could be successfully performed using processed smear-positive specimens (direct DST) and whether this method is accurate and may result in a significant reduction in time. The accuracy and shorter turnaround time of this approach were established by comparing the results acquired through direct DST with those obtained through indirect DST. Of the 150 acid-fast bacteria smear-positive sputum specimens that were set up for direct DST, 130 (86. 67%) produced results that could be reported. Direct DST reporting took an average of 10 days (range: 9-11 days). The time savings from direct DST to indirect DST, which took into account the time needed to isolate a culture and conduct DST, was 7 days on average (range: 6-9 days). When the direct and indirect DST results were compared, the concordance with levofloxacin (LFX), moxifloxacin (MOX), linezolid (LNZ), and clofazimine (CFZ) were 96. 33%, 96. 16%, 100%, and 99. 24%, respectively. The sensitivity and specificity of the test result were 93. 75%, 83. 33%, 100%, and 100%, and 98. 0, 99. 10, 100, and 99. 19% with an accuracy of 98%, 98%, 100%, and 99% for LFX, MOX, LNZ, and CFZ, respectively. Direct DST is a fast and accurate diagnostic technique for detecting second-line drug resistance in tuberculosis. The significance of this work is that it assesses whether direct drug susceptibility could be used in routine testing to save significant time, which is critical for early diagnosis of resistance and successful treatment.

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