Principle of pathogen-tailored individualized treatment design.

(A) Mutations are obtained from a whole-genome sequencing reference mapping approach that can be also transferred into a cgMLST for molecular outbreak surveillance. (B) Individual mutations are further interpreted towards their biological phenotype employing a validated consensus mutation catalogue. (C) When canonical and/or high-level resistance-conferring mutations are present, this drug should not be used. However, mutations associated with a moderate or intermediate resistance level may allow the use of drugs at increased doses. Moreover, mutations can be used to predict different treatment outcomes. Thus, by also considering phylogenetic benign mutations that do not confer resistance, a comprehensive molecular drug susceptibility profile could be inferred for a pathogen-tailored individualized treatment regimen in the future. cgMLST,core genome multilocus sequencing type; TB, tuberculosis.