UNLABELLED: Bedaquiline is a key drug recommended by the WHO for the treatment of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant (XDR) TB, and its use could potentially shorten treatment duration with improved outcomes. However, resistance against this drug has increased, resulting in serious concerns. Heteroresistance is among the important obstacles to complicate the detection and treatment of MTB drug resistance. We investigated the presence of bedaquiline heteroresistant MTB isolates from Pakistan to highlight their relevance to bedaquiline resistance. Whole genome sequencing of 50 phenotypically bedaquline-resistant and 50 bedaquiline-sensitive isolates revealed 29% bedaquiline heteroresistance in our study. No significant association of patient variables (age, gender, region and history of anti-tuberculosis treatment [ATT]) was found, while drug resistance pattern among MDR + bedaquiline and XDR patterns (OR, 0.53 [0.01-0.26]
IMPORTANCE: This research is decisive as it investigates bedaquiline heteroresistance in