Hidden Resistance: The Rising Significance of Non-RRDR rpoB Mutations in Multidrug-Resistant TB

Resistensi Tersembunyi: Meningkatnya Signifikansi Mutasi rpoB Non-RRDR pada TB yang Resisten terhadap Berbagai Obat

Abstract

This article aims to examine the role of non-RRDR mutations in the rpoB gene in rifampicin resistance and their implications for tuberculosis diagnosis. This study employed a literature review of scientific articles published between 2015 and 2025 focusing on rpoB mutations, rifampicin resistance, and diagnostic methods such as GeneXpert and whole genome sequencing (WGS). The results indicate that most rifampicin resistance is associated with mutations within the RRDR region; however, mutations outside the RRDR also contribute significantly to resistance. These non-RRDR mutations are often undetected by conventional diagnostic methods, potentially leading to false susceptible results. This condition may result in delayed diagnosis and inappropriate treatment. Therefore, non-RRDR mutations represent an important hidden resistance mechanism. The use of genomic technologies such as WGS is essential to improve diagnostic accuracy and support effective tuberculosis control.