Scientists have spotted signs of ‘pre-resistance’ in bacteria for the first time — signs that particular bacteria are likely to become resistant to antibiotics in the future — in a new study.

The findings, published in Nature Communications, will allow doctors in the future to select the best treatments for bacterial infections.

The team led by Great Ormond Street Hospital (GOSH) and the UCL Great Ormond Street Institute of Child Health, in collaboration with the Peruvian Tuberculosis programme and funded by Wellcome and the National Institutes of Health (USA), sequenced the full genomes of over 3,000 tuberculosis (TB) samples, tracing TB infections back through patients over nearly two decades.

Mycobacterium tuberculosis (TB) is a bacterial infection that largely affects the lungs. It was the second leading infectious cause of death after COVID-19 in 2020, killing 1.5m people. It can be cured if treated with the right antibiotics, but treatment is lengthy and many people most at risk lack access to adequate healthcare. Drug-resistant TB can develop when people do not finish their full course of treatment, or when drugs are not available or are of poor quality.

Multi-drug resistant TB represents a huge, unsustainable burden and totally drug resistant strains have been detected in a handful of countries. As health systems struggle to cope with the pandemic, progress on TB treatment globally has slowed.

In order to develop a better understanding of, and ultimately better treatments for, TB, this new research has identified for the first time how to pre-empt drug resistance mutations before they have occurred. The researchers have termed this concept ‘pre-resistance’: when a disease-causing organism — such as a virus or bacteria — has a greater inherent risk of developing resistance to drugs in the future.

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