Influence of multi-drug resistant mycobacterium strain on the management of bone and joint tuberculosis / 中华骨科杂志

ABSTRACT

Objective To investigate the influence of multi-drug resistant mycobacterium strain tuberculosis (MDR-TB) on the clinical outcomes and its countermeasures in the treatment of bone and joint tuberculosis. Methods From December 1993 to June 1999, 250 revised cases were admitted in our hospital, which were 143 males and 107 females aging from 2 to 72 years with an average of 25.44 years. The most of lesions were located at spine, then the hip, knee and small joints. The specimens were harvested via need biopsy or operation from the lesion. Specimens were examined by Bactec TB 460 to identify tuberculosis mycobacterium and non tuberculosis mycobacterium strain, and drugs-sensibility test to INH(0.2 ?g/ml), SM (6.0 ?g/ml), RFP (2.0 ?g/ml) and EMB (7.5 ?g/ml) respectively. Results Of 250 patients, Mycobacterium were positive in 48 by Bactec measurement, which were tuberculosis mycobacterium strain in 46 with 18.4% positive rate, and non tuberculosis mycobacterium strain in 2(1 mycobacterium avium intracellulare complex, the other unkown). Of the 46 positive specimens, 27 were sensitive to all of 4 drugs(58.7%), however, 3 were resistant to 1 drug(6.5%), 1 was resistant to 2 drugs(2.1%), 4 were resistant to 3 drugs (8.7%), and 11 were resistant to 4 drugs(24%). In 11 patients resistant to 4 drugs and 2 patients with non tuberculosis mycobacterium strain, 8 were complicated with sinuses after the first operation, in which 7 healed after 2 to 3 re-operations and 1 died of secondary infection. 1 M. avium intracellulare complex and 1 unidentified mycobacterium were multi-drug resistant strains( INH,RFP, SM, EMB) and found with poor clinical results.Conclusion Those cases with MDR-TB in lesions can influence the curative effect of bone and joint tuberculosis significantly. Based on the drug-sensibility, the chemotherapy regimen should be modified and individualized, and requires several operations to cure.