Introduction
Multidrug-resistant tuberculosis (MDR-TB)—defined as resistance to at least isoniazid (INH) and rifampicin (RIF)—remains a formidable public health issue globally and notably in China. The World Health Organization estimates that drug-resistant TB accounts for a substantial proportion of TB mortality, with challenges compounded by heterogeneous resistance mechanisms that complicate treatment. Hainan Island, the largest tropical island of China, presents unique socio-geographical and epidemiological contexts that influence the transmission dynamics and resistance profiles of Mycobacterium tuberculosis (MTB). However, prior to this study, comprehensive characterization of MDR-TB strains from this region, particularly integrative genotype-to-phenotype analyses, had been limited. This investigative work by Wang et al. addresses this gap by leveraging whole-genome sequencing (WGS) combined with phenotypic drug susceptibility testing (DST) to delineate resistance patterns and quantitatively link resistance-conferring mutations with drug minimum inhibitory concentration (MIC) levels, thereby informing region-specific therapeutic strategies.
