02419nas a2200301   4500000000100000008004100001260001200042653001100054653000800065653001400073653002000087653001200107653002200119653001700141100001400158700001500172700001500187700001600202700001100218700001300229700001500242700001200257700001700269245012000286300001300406520168400419022001402103       2022                            d  c04/202210aBrazil10aDNA10aM. leprae10aDrug Resistance10aleprosy10aSequence Analysis10aSurveillance1 aAndrade E1 aBrandão J1 ada Silva J1 aCoriolano C1 aRosa P1 aMoraes M1 aFerreira C1 aGomes C1 ade Araújo W00aAntimicrobial Resistance among Leprosy Patients in Brazil: Real-World Data Based on the National Surveillance Plan.  ae02170213 a<p>Brazil ranks second among countries for new cases and first for relapse cases of leprosy worldwide. The Mycobacterium leprae Resistance Surveillance Plan was established. We aimed to present the results of a 2-year follow-up of the National Surveillance Plan in Brazil. A cross-sectional study of leprosy cases was performed to investigate antimicrobial resistance (AMR) in Brazil from October 2018 to September 2020. Molecular screening targeting genes related to dapsone (), rifampin (), and ofloxacin resistance () was performed. During the referral period, 63,520 active leprosy patients were registered in Brazil, and 1,183 fulfilled the inclusion criteria for molecular AMR investigation. In total, only 16 (1.4%) patients had genetic polymorphisms associated with AMR. Of these, 8 (50%) had cases of leprosy relapse, 7 (43.8%) had cases of suspected therapeutic failure with standard treatment, and 1 (6.2%) was a case of new leprosy presentation. M. leprae strains with AMR-associated mutations were found for all three genes screened. Isolates from two patients showed simultaneous resistance to dapsone and rifampin, indicating multidrug resistance (MDR). No significant relationship between clinical variables and the presence of AMR was identified. Our study revealed a low frequency of AMR in Brazil. Isolates were resistant mainly to dapsone, and a very low number of isolates were resistant to rifampin, the main bactericidal agent for leprosy, or presented MDR, reinforcing the importance of the standard World Health Organization multidrug therapy. The greater frequency of AMR among relapsed patients supports the need to constantly monitor this group.</p>
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