Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India

Area of Science:

• Orthopedics
• Infectious Diseases
• Microbiology

Background:

• Spinal tuberculosis (TB) constitutes approximately 50% of osteoarticular tuberculosis cases.
• Rising drug resistance in spinal TB is a critical issue, particularly in the Indian subcontinent, which accounts for 24% of the global prevalence.
• Limited literature exists on the specific drug resistance patterns in spinal TB within this region.

Purpose of the Study:

• To investigate the prevalence and patterns of drug resistance in spinal tuberculosis.
• To analyze resistance to both first- and second-line anti-tuberculosis drugs.
• To provide data on drug resistance in a high-prevalence region.

Main Methods:

• A retrospective observational study was conducted on patients with spinal tuberculosis.
• Samples from affected vertebrae were cultured using BACTEC MGIT 960.
• Only treatment-naive patients with positive cultures were included.

Main Results:

• Out of 150 patients with positive cultures, 43 (28.6%) showed drug resistance.
• Multidrug resistance (MDR) was observed in 7 patients, pre-extensive drug resistance (pre-XDR) in 9, and extensive drug resistance (XDR) in 4.
• Isoniazid was the most common mono-drug resistance, and fluoroquinolones were frequently involved in second-line drug resistance.

Conclusions:

• The overall drug resistance rate in spinal tuberculosis was 28.6%.
• MDR, pre-XDR, and XDR accounted for 16.2%, 20.9%, and 9.3% of resistant cases, respectively.
• These findings highlight a significant burden of drug resistance in spinal TB, necessitating tailored treatment strategies.