P095

1:Centre national de reference des mycobactéries et résistance aux antituberculeux (CNR-MyRMA); 2:APHP Nord-Bichat Hospital, Universite Paris Cite, IAME UMR1137 Inserm; 3:3APHP Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, Paris, France

Antimicrobial resistance (AMR) surveillance is a main WHO objective for leprosy. Since Mycobacterium leprae cannot grow in vitro, AMR surveillance is done by molecular detection of mutations conferring resistance to rifampicin (RIF, rpoB), dapsone (DAP, folP1) and fluoroquinolones (FQ, gyrA).

From 2001 to 2023, skin samples from patients suspected of leprosy were subjected to microscopy and RLEP PCR to confirm or rule out the diagnosis. When positive, samples were further analysed by PCR sequencing or the test GenoType LepraeDR® to detect AMR.

Among 1359 skin samples from 1008 patients suspected of leprosy, 474 were positive (34.9%) corresponding to 378 patients (37.5%); 150 (39.7%) living in France metropolitan and 228 (60.3%) in French overseas territories. AMR detection was interpretable for 293 (77.5%) patients (256 new and 37 relapse cases); 272 being susceptible M. leprae strains while 22 (5.6%) harboured resistance to at least one antimicrobial. There were 13 primary resistance cases (11 DAP, 2 FQ) and 9 secondary resistance cases (5 DAP, 4 RIF). The primary resistance rate (5.1%) was significantly lower (p< 0,001) than the secondary resistance rate (24%). The mutations observed were as follows: P55L (n=10), T53I (n=5) T53A (n=1) for FolP1; S456L (n=2) and S456F(n=2) for RPOB; and A91V (n=2) in GyrA.

AMR surveillance in leprosy is crucial for detecting resistance patterns that may compromise the efficacy of antibiotic treatments and impede cure. It is essential to establish laboratory capacity and organisational frameworks to sustain long-term surveillance in both relapse and new case populations.