en Anti-microbial agents, resistance and treatment protocols Anti-microbial agents, resistance and treatment protocols Original article Original article <b><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Introduction:</span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Tuberculosis (TB) caused by the bacterium <i>Mycobacterium tuberculosis</i> remains a critical global public health concern due to the high morbidity and mortality rates.<i> </i>Mutation <a name="_Hlk153968005">in </a><i>atpE </i>and <i>Rv0678 </i>genes contributes to drug resistance in <a name="_Hlk155631092"><i>M. tuberculosis</i></a><i>.</i> This study investigates the antibiotic resistance patterns and mutations in <i>atpE</i> and <i>Rv0678 </i>genes in 22 <i>M. tuberculosis</i> clinical isolates. <b>Methods:</b> Drug susceptibility testing (DST) for rifampin, isoniazid, streptomycin, capreomycin, ofloxacin, kanamycin, and ethambutol was conducted using the proportional method. This was followed by determining the minimum inhibitory concentration (MIC) for bedaquiline (BDQ) via the <a name="_Hlk155634284">microplate Alamar blue assay </a>(MABA). Genomic regions encompassing <i>atpE</i> and <i>Rv0678</i> genes were amplified and sequenced for mutation analysis.</span></span></span> <span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Data analysis was performed using SPSS software to interpret mutation patterns concerning drug susceptibility profiles.<b> Results:</b></span></span></span> <span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Of 22 isolates, 5 (27.8%) were </span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">extensively drug-resistant <a name="_Hlk153199158">tuberculosis</a> (XDR-TB)</span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">, and 13 (72.2%) were </span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">multi-drug resistant tuberculosis (MDR-TB)</span></span></span><span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">. Resistance rates to kanamycin, ofloxacin, capreomycin, and streptomycin were 40.6%, 46.3%, 85%, and 74.6%, respectively. Additionally, phenotypic resistance to bedaquiline was observed in 12 (54.5%) isolates. Sequencing revealed no resistance-conferring mutations in the <i>atpE</i> or <i>Rv0678</i> genes among the isolates.<b> Conclusion:</b></span></span></span> <span style="font-size:10.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">Our findings showed substantial resistance to first- and second-line drugs in <i>M. tuberculosis</i> clinical isolates. This highlights the necessity for ongoing, comprehensive studies to elucidate the evolving drug resistance patterns and understand the underlying mechanisms in clinical isolates</span></span></span><span style="font-size:12.0pt"><span style="line-height:107%"><span new="" roman="" style="font-family:" times="">.</span></span></span> Mycobacterium tuberculosis, DST, atpE, Rv0678, Bedaquiline, Extensively drug-resistant tuberculosis (XDR-TB), Multi-drug resistant tuberculosis (MDR-TB) 179 184 http://jommid.pasteur.ac.ir/browse.php?a_code=A-10-539-1&slc_lang=en&sid=1 Nahid Madadi-Goli nahidmadadi67@gmail.com 0000-0002-4531-3081 No 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran; 3Student Research Committee, Pasteur Institute of Iran, Tehran, Iran Kamal Ahmadi kamalrokh1990@gmail.com 0000-0002-9830-6651 No 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran; 3Student Research Committee, Pasteur Institute of Iran, Tehran, Iran Sharareh Khanipour shararehkhanipour@yahoo.com 0009-0000-2188-136X No 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran Shahin Pourazar Dizaji Shahinpoor@yahoo.com 0009-0003-3960-6819 No 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran Mahshid Nasehi mnasehi@yahoo.com 0000-0002-2913-4294 No 4Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran; 5Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran Seyed Davar Siadat sd_siadat@yahoo.com 0000-0002-6892-5603 No 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran Farzam Vaziri farzam_vaziri@yahoo.com 0000-0001-7788-2548 No Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran Abolfazl Fateh afateh2@gmail.com 0000-0002-2043-8523 Yes 1Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran, Tehran, Iran