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Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients

Abstract

Purpose

To evaluate the sensitivity patterns of anti-tubercular drugs in Xpert MTB-positive spinal tuberculosis (TB) patients and to formulate the guidelines for early start of empiric anti-tubercular treatment (ATT) in MDR-TB spine based on resistance pattern in this large series.

Methods

It was a cross-sectional observational study of 252 consecutive patients who were Xpert MTB-proven spinal TB cases with retrospective analysis of prospective data. The Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay was used to diagnose spinal TB and RIF resistance. All patients underwent drug sensitivity testing (DST) to 13 commonly used anti-tubercular drugs using BACTEC MGIT-960 system. The drug sensitivity pattern of primary and secondary anti-tubercular drugs was recorded and compared.

Results

The DST study revealed 110 (43.6%) cases of multi-drug resistant (MDR—resistance to both isoniazid and rifampicin) and 24 (9.5%) cases of non-MDR-TB spine. The widespread resistance was found for both isoniazid (91%) and rifampicin (85%), followed by streptomycin (61.9%). The least resistance was found for kanamycin, amikacin and capreomycin and no resistance found for clofazimine.

Conclusion

The Xpert MTB/RIF assay is an efficient technique for the rapid diagnosis of spinal TB and suspected MDR-TB; however, it is recommended to do culture and DST in all patients with spinal TB to guide the selection of appropriate second-line drugs when required. In cases of non-availability of culture and DST, it is suggested to use data from large series such as this to plan the best empirical ATT regimen.

Graphic abstract

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Correspondence to Jwalant Patel.

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Upadhyay, M., Patel, J., Kundnani, V. et al. Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients. Eur Spine J (2020). https://doi.org/10.1007/s00586-020-06305-x

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Keywords

  • Spinal tuberculosis
  • MDR-TB
  • Xpert MTB/RIF
  • Drug sensitivity testing
  • Anti-tubercular drugs
  • Second-line drugs