抗药性骨,关节和脊柱结核病:诊断和治疗的演变
Anil K Jain1, Pragya Jain1, Karan Jaggi1
1University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India.
Indian journal of orthopaedics
|May 30, 2024
概括
耐药性骨关节结核病 (OATB) 需要一个明确的诊断和治疗算法. 这项研究开发了一种方法,有效地调查和管理治疗不耐药或可能耐药的OATB病例.
科学领域:
- 整形外科 整形外科 整形外科
- 传染性疾病 传染性疾病
- 微生物学 微生物学
背景情况:
- 耐药性骨关节结核病 (OATB) 由于深层病变和低细菌负载,存在诊断和治疗方面的挑战.
- 目前用于调查和治疗耐药性 (DR) OATB,特别是假定耐药性 (PDR) 或治疗耐药性疾病 (TRD) 的协议缺乏清晰度和证据.
研究的目的:
- 开发和验证一种用于研究和治疗治疗性耐药性疾病 (TRD) 或骨关节结核病 (OATB) 中假定耐药性 (PDR) 的算法.
主要方法:
- 进行了六项研究,包括TRD/PDR标准的评估,使用AFB涂抹,培养,组织学和基因型药物敏感性测试 (DST) 通过CBNAAT和LPA对OATB病例的调查.
- 此外,还进行了对已证实或临床耐药性 (CDR) 治疗的DR OATB病例的回顾性评估.
主要成果:
- 在5个月的抗结核治疗 (ATT) 后,出现治疗反应不佳的骨/脊柱结核病患者被确定为PDR病例.
- 通过基因型和表型DST通过已证实DR的结核病组织学确认导致成功治疗. 没有确的DST病例在MDR协议上被视为CDR.
结论:
- 提出了一个算法,强调基于定义的标准对PDR/TRD的怀疑.
- 为AFB涂抹,组织学和基因型/表型DST采购组织对于诊断和耐药性分析至关重要.
- 具有强烈临床怀疑DR但不确定的DST (<10%) 的病例可以在MDR协议上作为CDR进行管理,并对不良影响进行勤奋监测.
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