Gain Amartya, Jain Anil K, Bhalla Manpreet, Aggarwal Aditya N, Dhammi Ish K, Arora Vinod K
Orthopaedics, University College of Medical Sciences, New Delhi, IND.
Microbiology, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, IND.
Cureus. 2023 Aug 26;15(8):e44173. doi: 10.7759/cureus.44173. eCollection 2023 Aug.
The present study was undertaken to determine the incidence of drug resistance against anti-tubercular drugs among patients from an endemic zone. Methodology: Forty consecutive clinico-radiologically diagnosed patients of osteoarticular tuberculosis (29: spine, 11: extraspinal) were enrolled. Pus from needle aspiration was taken in 31 cases, tissue following spinal decompression in seven, synovial in one, and sinus edge biopsy in one. The pus/tissue was subjected to acid-fast bacilli (AFB) staining and liquid culture, sensitivity to 13 anti-tubercular drugs (Isoniazid (INH), rifampicin (RIF), kanamycin (KAN), amikacin (AMK,) capreomycin (CAP), ethionamide (ETH), levofloxacin (LEV), moxifloxacin (MOX), linezolid (LNZ), para-amino-salicylic acid (PAS), bedaquiline (BDQ), delamanid (DLM), and clofazimine (CFO)) were checked, and histopathological/cytopathological examination and molecular tests were performed. Results: The mean age of patients was 29.07(9-65) years; 21 were female and 19 were male. The diagnostic accuracy for tuberculosis was 20% by AFB smear, 65% by liquid culture, 82.5% by histopathology, and 90% by cartridge-based nucleic acid amplification testing (CBNAAT). All culture-positive isolates were identified as with no non-tubercular . The drug resistance detected on CBNAAT was 11.1%, line probe assay (LPA) first line was 15.4%, LPA second line was 4%, and liquid drug susceptibility testing (DST) 11.5%. We detected 15.4% INH resistance, 11.1% RIF, 7.6% LEV, 3.8% MOX and PAS. No resistance was detected against second-line injectable drugs (SLID), ETH, LNZ, BDQ, DLM, and CFO. Conclusions: No single laboratory modality can ascertain the diagnosis in all cases; hence, samples should be sent for all tests in tandem. In the presence of insufficient samples, tissue may be subjected to CBNAAT and histopathology to arrive at tissue diagnosis. In this subset, overall drug resistance incidence was 12.5% (5/40) with one patient each of isolated INH and RIF resistance, one of multidrug-resistance (MDR), and two of pre-extensively drug-resistant (pre-XDR). Primary drug resistance came out to be 11.1% (4/36) with one patient each of isolated INH and RIF resistance, one of MDR, and one Pre-XDR.
本研究旨在确定来自地方病区的患者中抗结核药物耐药性的发生率。方法：连续纳入40例经临床放射学诊断的骨关节炎结核病患者（29例脊柱结核，11例脊柱外结核）。31例患者采用针吸脓液，7例患者采用脊柱减压后的组织，1例患者采用滑膜组织，1例患者采用窦道边缘活检组织。对脓液/组织进行抗酸杆菌（AFB）染色和液体培养，检测其对13种抗结核药物（异烟肼（INH）、利福平（RIF）、卡那霉素（KAN）、阿米卡星（AMK）、卷曲霉素（CAP）、乙硫异烟胺（ETH）、左氧氟沙星（LEV）、莫西沙星（MOX）、利奈唑胺（LNZ）、对氨基水杨酸（PAS）、贝达喹啉（BDQ）、德拉马尼（DLM）和氯法齐明（CFO））的敏感性，并进行组织病理学/细胞病理学检查和分子检测。结果：患者的平均年龄为29.07（9 - 65）岁；女性21例，男性19例。AFB涂片对结核病的诊断准确率为20%，液体培养为65%，组织病理学为82.5%，基于 cartridge 的核酸扩增检测（CBNAAT）为90%。所有培养阳性分离株均被鉴定为结核分枝杆菌，无非结核分枝杆菌。CBNAAT检测到的耐药率为11.1%，线性探针分析（LPA）一线药物耐药率为15.4%，LPA二线药物耐药率为4%，液体药物敏感性试验（DST）为11.5%。我们检测到INH耐药率为 .4%，RIF为11.1%，LEV为7.6%，MOX和PAS为3.8%。未检测到对二线注射药物（SLID）、ETH、LNZ、BDQ、DLM和CFO的耐药性。结论：没有单一的实验室检测方法能在所有病例中确诊；因此，应同时送检样本进行所有检测。在样本不足的情况下，可对组织进行CBNAAT和组织病理学检查以进行组织诊断。在这一亚组中，总体耐药发生率为12.5%（5/40），其中分别有1例患者为单纯INH和RIF耐药，1例为耐多药（MDR），2例为广泛耐药前（pre-XDR）。原发性耐药率为11.1%（4/36），其中分别有1例患者为单纯INH和RIF耐药，1例为MDR，1例为pre-XDR。
