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논문 기본 정보

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학술저널
저자정보
Justin Arockiaraj (Department of Orthopaedics Christian Medical College and Hospital Vellore India) Rajiv Karthik (Medicine Christian Medical College Vellore India) Joy Sarojini Michael (Microbiology Christian Medical College and Hospit) Rohit Amritanand (Spinal Disorder Sugery Unit Department of Orthopaedics Christian Medical College Vellore India) Kenny Samuel David (Spinal Disorder Sugery Unit Department of Orthopaedics Christian Medical College Vellore India) Venkatesh Krishnan (Spinal Disorder Sugery Unit Department of Orthopaedics Christian Medical College Vellore India) Gabriel David Sundararaj (Department of Orthopaedics Christian Medical College and Hospital Vellore India)
저널정보
대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.13 No.2
발행연도
2019.1
수록면
265 - 271 (7page)

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Study Design: Retrospective study. Purpose: To report the prevalence of patients with multidrug-resistant (MDR) tubercular spondylodiscitis and their outcomes. Additionally, to assess the role of Xpert MTB/RIF assay in early detection of MDR tuberculosis. Overview of Literature: MDR tuberculosis is increasing globally. The World Health Organization (WHO) has strongly recommended Xpert MTB/RIF assay for early detection of tuberculosis. Methods: From 2006 to 2015, a retrospective study was conducted on patients treated for MDR tuberculosis of the spine. Only patients whose diagnosis was confirmed using either culture and/or the Xpert MTB/RIF assay were included. Diagnostic method, treatment regimen, time taken to initiate second-line antituberculosis treatment (ATT), drug-related complications, and cost of medications were analyzed. All patients with MDR were treated according to the WHO recommendations for 2 years. The outcome parameters analyzed included clinical, biochemical, and radiological criteria to assess healing status. Results: From 2006 to 2015, a total of 730 patients were treated for tubercular spondylodiscitis. Of those, 36 had MDR tubercular spondylitis (prevalence, 4.9%), and three had extremely drug resistant tubercular spondylitis (prevalence, 0.4%). In this study, 30 patients, with a mean age of 29 years and a mean post-treatment follow-up of 24 months, were enrolled. The majority (77%) had secondary MDR, 17 (56%) underwent surgery, and 26 (87%) completed treatment for 2 years and were healed. Drug-related complications (33%) included ototoxicity, hypothyroidism, and hyperpigmentation of the skin. The average time taken for initiation of second line ATT for MDR patients with Xpert MTB/RIF assay as the diagnostic tool was 18 days, when compared to patients for whom the assay was not available which was 243 days. Conclusions: The prevalence of MDR tubercular spondylodiscitis was 4.9%. In total, 87% of patients were healed with adequate treatment. The sensitivity and specificity of the Xpert MTB/RIF assay to detect MDR was 100% and 92.3%, respectively.
#Multi drug resistance #Tuberculosis #Diagnosis #Treatment

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참고문헌 (21)

참고문헌 신청
World Health Organization / Use of high burden country lists for TB by WHO in the post-2015 era google schola World Health Organization / Global tuberculosis report 2018 google schola World Health Organization / 2013 / XpertMTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update google schola Jain AK / 2012 / Tuberculosis spine : therapeutically refractory disease / Indian J Orthop 46:171~178 google schola Pawar UM / 2009 / Multidrug-resistant tuberculosis of the spine : is it the beginning of the end? : a study of twenty-five culture proven multidrug-resistant tuberculosis spine patients / Spine(Phila Pa 1976) 34:E806~E810 google schola

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