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Treatment Outcome of Drug-Resistant Skeletal Tuberculosis: A Retrospective Analysis

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Abstract

Background

Management outcomes of drug-resistant (DR) osteoarticular tuberculosis (OATB) is dismal as in pre-ATT era (1905). The studies documenting treatment outcome of DR-OATB are scarce; hence, present retrospective analysis was conducted to evaluate outcome of consecutive cases of DR-OATB.

Methods

45 consecutive patients of suspected DR-OATB were treated from 2010 onwards. Tissue samples were submitted for AFB smear, cytology/histology, liquid culture, CBNAAT/LPA besides gram’s staining and aerobic/anaerobic culture. Patients were treated by individualized second-line ATT till documenting healed status by contrast MRI/PET. The changes in neurological deficit, deformities, and drug-induced adverse events were documented.

Results

37/45 patients, 15 males and 22 females, mean age 26.89 years were followed. DR was suspected observing poor clinico-radiological response/appearance of fresh lesions on ATT. All showed no growth on aerobic/anaerobic pyogenic culture. 29 (78%) had microbiologically proven drug resistance and 8 (22%) were labeled as clinical drug resistance (CDR). 18/29 had multi-drug resistance. Mean prior ATT intake was 12.03 months 15 (40%) underwent surgical decompression. Mean duration of second-line ATT was 22.5 months (9–36 months). All patients achieved healed status with 8 (21%) developed side effects, most commonly hepatotoxicity, ototoxicity, and psychiatric disturbances. Average follow-up after completion of ATT was 40.5 months.

Conclusion

We report a large series where patients of DR-OATB were suspected on clinical criteria, investigated by DST, and treated. Patients with proven drug resistance were treated by individualized second-line ATT. CDR cases were treated by MDR protocol. Genotypic DST (CBNAAT/LPA) improved demonstration of DR. We demonstrated healed status on MRI/PET with no recurrence at minimum 2-year follow-up.

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Authors and Affiliations

  1. Department of Orthopaedics, Dilshad Garden, University College of Medical Sciences & Associated Guru Teg Bahadur Hospital, Delhi, 110095, India

    Himanshu Gupta, Rajesh Arora, Manish Chadha, I. K. Dhammi & Anil K. Jain

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  1. Himanshu Gupta
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  2. Rajesh Arora
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Correspondence to Anil K. Jain.

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This retrospective analysis was conducted after taking institutional ethics committee approval and informed consent of all patients was also obtained.

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Gupta, H., Arora, R., Chadha, M. et al. Treatment Outcome of Drug-Resistant Skeletal Tuberculosis: A Retrospective Analysis. JOIO 58, 402–411 (2024). https://doi.org/10.1007/s43465-024-01110-w

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