Multidrug-Resistant and Extensively Drug-Resistant Skeletal Tuberculosis: Systematic Review of Clinical Profile,...

Area of Science:

• Orthopedics
• Infectious Diseases
• Microbiology

Background:

• Drug-resistant tuberculosis, including multidrug-resistant (MDR), pre-extensively drug-resistant (pre-XDR), and extensively drug-resistant (XDR) strains, leads to significant morbidity and treatment challenges.
• Skeletal tuberculosis (TB) presents unique diagnostic and therapeutic hurdles, particularly when caused by resistant strains.

Purpose of the Study:

• To systematically review the clinical spectrum, diagnostic approaches, resistance patterns, treatment strategies, surgical interventions, and outcomes of drug-resistant skeletal TB.

Main Methods:

• A comprehensive systematic search of PubMed, Scopus, and Embase databases was conducted up to September 2025.
• Studies included were those reporting ≥5 culture- or molecular-confirmed cases of MDR, pre-XDR, or XDR skeletal TB.
• Data extracted encompassed demographics, clinical features, diagnostic methods, drug susceptibility testing, treatment regimens, surgical management, and patient outcomes.

Main Results:

• The review analyzed 20 studies involving 1,242 cases of drug-resistant skeletal TB (1,032 spinal, 210 osteoarticular).
• MDR TB was the predominant form, with pre-XDR/XDR cases accounting for 1.2–20%.
• Treatment success rates ranged from 76–100% for MDR TB and 50–80% for pre-XDR/XDR TB, with adverse events in 33–55%. Recurrence and mortality rates were low (<5–19%).

Conclusions:

• MDR TB is the leading cause of drug-resistant skeletal TB, though pre-XDR/XDR cases necessitate intricate management strategies.
• Optimal outcomes depend on early molecular diagnosis, individualized multidrug regimens, and appropriate surgical interventions.
• A multidisciplinary approach is crucial for enhancing prognosis and minimizing long-term patient morbidity.