PDF Online Survey Instrument

Confidential

Drug Susceptibility Test Results for M. tuberculosis
Complex Isolates from the CDC Model Performance
Evaluation Program

Page 1

Form Approved
OMB No. 0920-0600
Expiration Date: XX/XX/20XX
CDC estimates the average public reporting burden for this collection of information as 15 minutes per response,
including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining
the data/information needed, and completing and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review
Office, 1600 Clifton Road NE, MS H21-8, Atlanta, Georgia 30333; ATTN: PRA (0920-0600).

Instructions

For each survey submitted, two growth-based drug susceptibility test methods and three molecular test method can
be entered.
Sensititre, if performed, must be entered as the first method.

All results for the MPEP survey must be entered at one time.
For questions or comments, contact [email protected].

*Enter MPEP number  ______
*Name of person completing form  ______
*Title  ______
*Email  ______
*must provide value
Enter MPEP number
__________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 2

Please indicate the primary classification of your laboratory
Hospital
Public Health (e.g., local, county, state, territorial)
Independent/Reference (non-hospital based)
Federal
Other
Please describe your laboratory classification
__________________________________
On what date were the MPEP cultures received in your laboratory?
__________________________________
Upon arrival, what was the condition of the cultures in the panel?
Satisfactory
Unsatisfactory
Please describe the unsatisfactory condition of the cultures when they arrived
__________________________________
In the last calendar year (January 1 - December 31, 2024), how many isolates of M. tuberculosis complex (MTBC) did
your laboratory test for drug susceptibilities? (Please exclude quality control isolates)
__________________________________
Did your laboratory perform MTBC growth-based drug
susceptibility testing (DST) for the panel in this
shipment?

Yes
No

What method was performed in your laboratory for MTBC
growth-based drug susceptibility testing (DST) for
testing the panel in this shipment?
(Only one method can be selected. If multiple methods
were performed, there will be an opportunity to enter
those results after the first method.)

Agar Proportion (Middlebrook 7H10 or 7H11)
MGIT System
MIC Testing
VersaTrek Myco

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 3

Isolate 2025A
Please enter your growth-based DST results
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
Did your laboratory perform growth-based DST on
additional drugs by the initial method selected?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Rifabutin
Ethionamide
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 4

Isolate 2025B
Please enter growth-based drug susceptibility results
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
Did your laboratory perform growth-based DST on
additional drugs by the initial method selected?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 5

Isolate 2025C
Please enter growth-based drug susceptibility results
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
Did your laboratory perform growth-based DST on
additional drugs by the initial method selected?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 6

Isolate 2025D
Please enter growth-based drug susceptibility results
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
Did your laboratory perform growth-based DST on
additional drugs by the initial method selected?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazamine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 7

Isolate 2025E
Please enter growth-based drug susceptibility results
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
Did your laboratory perform growth-based DST on
additional drugs by the initial method selected?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________
Please provide the specific MIC testing method
performed

__________________________________

Isolate 2025A MIC Testing Results  
  Enter MIC drug susceptibility interpretation Enter quantitative MIC results (ug/ml)
Rifampin ______ ______
Isoniazid low ______ ______
Isoniazid high ______ ______
Ethambutol ______
______
Streptomycin
______ 12:04pm
09/04/2025

projectredcap.org

______
Ofloxacin
______
______
Ciprofloxacin
______
______
Moxifloxacin
______
______
Levofloxacin
______
______
Amikacin
______
______
Kanamycin
______
______
Capreomycin
______
______
Ethionamide
______
______
Rifabutin
______
______
Cycloserine
______

______
Para-aminosalicylic Acid
______
______
Rifapentine
______
______
Bedaquiline
______
______
Linezolid
______
______
Clofazimine
______
______
Delamanid
______
______
Pretomanid
______
______

Additional MIC Comments
__________________________________________

Confidential
Page 10

Isolate 2025B MIC Testing Results  
  Enter MIC drug susceptibility interpretation Enter quantitative MIC results (ug/ml)
Rifampin ______ ______
Isoniazid low ______ ______
Isoniazid high ______ ______
Ethambutol ______ ______
Streptomycin ______ ______
Ofloxacin ______ ______
Ciprofloxacin ______ ______
Moxifloxacin ______ ______
Levofloxacin ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Rifabutin ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Rifapentine ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional MIC Comments
__________________________________________
Isolate 2025C MIC Testing Results  
  Enter MIC drug susceptibility interpretation Enter quantitative MIC results (ug/ml)
Rifampin ______ ______
Isoniazid low ______ ______
Isoniazid high ______ ______
Ethambutol ______ ______
Streptomycin ______ ______
Ofloxacin ______ ______
Ciprofloxacin ______ ______
Moxifloxacin ______ ______
Levofloxacin ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Rifabutin ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Rifapentine ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional MIC Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 11

Isolate 2025D MIC Testing Results  
  Enter MIC drug susceptibility interpretation Enter quantitative MIC results (ug/ml)
Rifampin ______ ______
Isoniazid low ______ ______
Isoniazid high ______ ______
Ethambutol ______ ______
Streptomycin ______ ______
Ofloxacin ______ ______
Ciprofloxacin ______ ______
Moxifloxacin ______ ______
Levofloxacin ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Rifabutin ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Rifapentine ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional MIC Comments
__________________________________________
Isolate 2025E MIC Testing Results  
  Enter MIC drug susceptibility interpretation Enter quantitative MIC results (ug/ml)
Rifampin ______ ______
Isoniazid low ______ ______
Isoniazid high ______ ______
Ethambutol ______ ______
Streptomycin ______ ______
Ofloxacin ______ ______
Ciprofloxacin ______ ______
Moxifloxacin ______ ______
Levofloxacin ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Rifabutin ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Rifapentine ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional MIC Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 12

Did your laboratory perform a second growth-based DST
method?

Yes
No

Select the second growth-based DST method:

Agar Proportion
MGIT System
VersaTrek Myco

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 13

Isolate 2025A--Test Method 2
For your second growth-based method, enter drug susceptibility results.
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
For this second test method, did your laboratory
perform DST on additional drugs?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 14

Isolate 2025B--Test Method 2
For your second growth-based method, enter drug susceptibility results.
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
For this second test method, did your laboratory
perform DST on additional drugs?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 15

Isolate 2025C--Test Method 2
For your second growth-based method, enter drug susceptibility results.
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
For this second test method, did your laboratory
perform DST on additional drugs?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 16

Isolate 2025D--Test Method 2
For your second growth-based method, enter drug susceptibility results.
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
For this second test method, did your laboratory
perform DST on additional drugs?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-Aminosalicylic Acid
Rifapentine
Clofazamine
Delamanid
Pretomanid
Comments
__________________________________________

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 17

Isolate 2025E--Test Method 2
For your second growth-based method, enter drug susceptibility results.
Susceptible

Resistant

Intermediate

Contaminated
No
/ No Growth Interpretation

Not Done

Contaminated
No
/ No Growth Interpretation

Not Done

Rifampin
Isoniazid low
Isoniazid high
Ethambutol
Pyrazinamide
Streptomycin
For this second test method, did your laboratory
perform DST on additional drugs?
Susceptible

Yes
No
Resistant

Intermediate

Ofloxacin
Ciprofloxacin
Moxifloxacin
Levofloxacin
Amikacin
Kanamycin
Capreomycin
Ethionamide
Rifabutin
Cycloserine
Para-Aminosalicylic Acid
Rifapentine
Bedaquiline
Linezolid
Clofazimine
Delamanid
Pretomanid
Comments
__________________________________________
Did your laboratory perform detection of drug
resistance using a molecular method?

09/04/2025 12:04pm

Yes
No

projectredcap.org

Confidential
Page 18

Please select the molecular method performed

Xpert MTB/RIF (Cepheid)
Genotype MTDRplus/MTDRsl (Hain Lifescience)
Conventional Targeted DNA Sequencing (e.g.,
pyrosequencing, Sanger)
Next Generation Targeted DNA Sequencing (e.g.,
Illumina amplicon sequencing, Deeplex Myc-TB,
Nanopore)
Whole Genome Sequencing
Other method

Please provide the specific Next Generation Targeted
DNA sequencing method performed

__________________________________

Please provide the specific Whole Genome Sequencing
method performed

__________________________________

Please provide the Other molecular method performed

__________________________________

Isolate 2025A Molecular Results Please enter your reportable molecular results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025B Molecular Results Please enter your reportable molecular results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine
______ ______
09/04/2025
12:04pm

projectredcap.org

Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025C Molecular Results Please enter your reportable molecular results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025D Molecular Results Please enter your reportable molecular results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________

Confidential
Page 20

Isolate 2025E Molecular Results Please enter your reportable molecular results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Did your laboratory perform a second molecular method
for detection of drug resistance?

Yes
No

Please select the molecular method performed

Xpert MTB/RIF (Cepheid)
Genotype MTDRplus/MTDRsl (Hain Lifescience)
Conventional Targeted DNA Sequencing (e.g.,
pyrosequencing, Sanger)
Next Generation Targeted DNA Sequencing (e.g.,
Illumina amplicon sequencing, Deeplex Myc-TB,
Nanopore)
Whole Genome Sequencing
Other method

Please provide the specific Next Generation Targeted
DNA sequencing method performed

__________________________________

Please provide the specific Whole Genome Sequencing
method performed

__________________________________

Please provide the Other molecular method performed

__________________________________

Isolate 2025A Molecular Results--Test Method 2 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
09/04/2025
Linezolid12:04pm
______ ______

projectredcap.org

Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025B Molecular Results--Test Method 2 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025C Molecular Results--Test Method 2 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Confidential
Page 22

Additional Molecular Comments
__________________________________________
Isolate 2025D Molecular Results--Test Method 2 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025E Molecular Results--Test Method 2 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Did your laboratory perform a third molecular method
for detection of drug resistance?

09/04/2025 12:04pm

Yes
No

projectredcap.org

Confidential
Page 23

Please select the molecular method performed

Xpert MTB/RIF (Cepheid)
Genotype MTDRplus/MTDRsl (Hain Lifescience)
Conventional Targeted DNA Sequencing (e.g.,
pyrosequencing, Sanger)
Next Generation Targeted DNA Sequencing (e.g.,
Illumina amplicon sequencing, Deeplex Myc-TB,
Nanopore)
Whole Genome Sequencing
Other method

Please provide the specific Next Generation Targeted
DNA sequencing method performed

__________________________________

Please provide the specific Whole Genome Sequencing
method performed

__________________________________

Please provide the Other molecular method performed

__________________________________

Isolate 2025A Molecular Results--Test Method 3 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025B Molecular Results--Test Method 3 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

09/04/2025 12:04pm

projectredcap.org

Confidential
Page 24

Additional Molecular Comments
__________________________________________
Isolate 2025C Molecular Results--Test Method 3 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025D Molecular Results--Test Method 3 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
Capreomycin ______ ______
Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Isolate 2025E Molecular Results--Test Method 3 Please enter your reportable molecular DST results.
  Enter molecular results Enter specific mutation(s) detected
Rifamycins (Rifampin, Rifabutin, Rifapentine) ______ ______
Isoniazid ______ ______
Ethambutol ______ ______
Pyrazinamide ______ ______
Streptomycin ______ ______
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin) ______ ______
Amikacin ______ ______
Kanamycin ______ ______
09/04/2025
12:04pm
Capreomycin
______ ______

projectredcap.org

Ethionamide ______ ______
Cycloserine ______ ______
Para-aminosalicylic Acid ______ ______
Bedaquiline ______ ______
Linezolid ______ ______
Clofazimine ______ ______
Delamanid ______ ______
Pretomanid ______ ______

Additional Molecular Comments
__________________________________________
Thank you for completing the survey.
Upon submission, you will have the opportunity to save a copy of your submitted responses.  
Please either download a PDF copy  or send a PDF copy by email on the next screen.