Orthopaedics Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China.
Medical Records Department, Beijing Chest Hospital, Capital Medical University/ Beijing Tuberculosis & Thoracic Tumor Research Institute, Beijing, China.
Front Public Health. 2022 Jun 17;10:901504. doi: 10.3389/fpubh.2022.901504. eCollection 2022.
Spinal tuberculosis (TB) is one of the most common forms of extrapulmonary tuberculosis, causing increased morbidity and lifelong disabilities. Here, we conducted a retrospective study to determine the impact on patient outcomes of the Xpert MTB/RIF test vs. phenotypical drug susceptibility testing for spinal TB.
In-patients with spinal TB were enrolled in 2013 and 2017 at Beijing Chest Hospital. Data were collected from an electronic patient record system that documented demographic and clinical characteristics. All the patients were routinely followed-up at 1, 3, 6, 9, and 12 months after surgery during outpatient treatment.
A total of 361 patients affected by spinal TB were enrolled in our analysis, including 178 patients in 2013 and 183 patients in 2017. In 2013, the cumulative postoperative recurrence rate of patients with spinal TB was 23% (41/178), which was significantly higher than that in 2017 (8.2%, 15/183, < 0.001). Additionally, the patients with spinal TB diagnosed in 2013 relapsed significantly sooner than those in 2017 ( < 0.001). In the multivariate analysis, rifampicin (RIF) resistance was associated with the recurrence of spinal TB. The turnaround time of Xpert ranged from 1 to 3 days, with a median of 1 day (IQR: 1-2). For the phenotypic drug susceptibility test (pDST)-based algorithm, the median turnaround time was 67 days, considerably longer than that of the Xpert-based algorithm ( < 0.001).
The RIF resistance is an independent risk factor for postoperative recurrence in patients with spinal TB. Early detection of RIF resistance due to the application of Xpert is an effective strategy to reduce spinal TB recurrence.
脊柱结核（TB）是最常见的肺外结核形式之一，导致发病率增加和终身残疾。在这里，我们进行了一项回顾性研究，以确定 Xpert MTB/RIF 检测与脊柱结核表型药物敏感性检测对患者结局的影响。
2013 年和 2017 年，北京胸科医院收治了脊柱结核住院患者。数据来自电子病历系统，记录了人口统计学和临床特征。所有患者在术后门诊治疗期间，分别在 1、3、6、9 和 12 个月进行常规随访。
本研究共纳入 361 例脊柱结核患者，其中 2013 年 178 例，2017 年 183 例。2013 年，脊柱结核患者的术后累积复发率为 23%（41/178），明显高于 2017 年（8.2%，15/183，<0.001）。此外，2013 年诊断的脊柱结核患者复发时间明显早于 2017 年（<0.001）。多因素分析显示，利福平（RIF）耐药与脊柱结核复发有关。Xpert 的周转时间为 1-3 天，中位数为 1 天（IQR：1-2）。对于基于表型药物敏感性试验（pDST）的算法，中位数周转时间为 67 天，明显长于基于 Xpert 的算法（<0.001）。
RIF 耐药是脊柱结核患者术后复发的独立危险因素。由于应用 Xpert，早期发现 RIF 耐药是降低脊柱结核复发的有效策略。
