Therapeutic efficacy of drug susceptibility test-guided individualized anti-tuberculosis chemotherapy for spinal tuberculosis / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the efficacy of individualized anti-tuberculosis chemotherapy guided by drug susceptibility testing for spinal tuberculosis through analyses on the post-operative follow-up outcomes.</p><p><b>METHODS</b>The diagnoses of spinal tuberculosis were established by clinical, radiological and histological evaluation in 132 patients who were admitted from August 2005 to January 2010, 62 patients (37 male and 25 female) with follow-up more than 12 months in this study. The average age was 33.6 years (ranging from 4 - 67 years). The infected samples were collected during surgery. After processed in a routine laboratory procedure, the samples were inoculated into vials of the BACT/ALERT 3D system. The drug susceptibility testing was performed using absolute concentration method, which included 11 first-line and second-line drugs. Four or five anti-tuberculosis drug regimen was chosen according to the results of drug susceptibility testing. All the patients were followed up a month later, and then once 3 months in the following 11 months, and subsequently at intervals of half a year. The clinical status, erythrocyte sedimentation rate (ESR), roentgenogram, MRI and 3D-CT were concerned to estimate the progress of tuberculosis.</p><p><b>RESULTS</b>The culture positive rate was 45.2% (28/62). The average detection time was 42 d (ranging from 28 - 58 d). The drug susceptibility testing showed a total drug resistance level of 24.2%12.9% for isoniazid, 4.8% for rifampicin, 3.2% for ethambutol, 9.7% for streptomycin, 6.4% for pasiniazid, 14.5% for levofloxacin, 1.6% for rifapentine. The mean follow-up period was 21 months (ranging from 12 - 44 months). According to Bridwell criteria, grade I bony fusion was obtained in all patients in 8 - 12 months.</p><p><b>CONCLUSION</b>Guided by drug susceptibility testing, individualized anti-tuberculosis chemotherapy for 12 to 18 months is effective for spinal tuberculosis.</p>