Abstract:

Objective To evaluate short-term effectiveness of individualized treatment under the guidance of phenotypic and molecular drug susceptibility tests(DST) for patients with drug-resistant osteoarticular tuberculosis. Methods Using retrospective analysis, 112 cases of osteoarticular tuberculosis patients who received focal cleaning operation were enrolled between March to December 2018 in Chest Hospital of Xinjiang Uyghur Autonomous Region. BACTEC MGIT 960 and MTBDRplus-LPA were used for conducting DST. There were 23 drug-resistant patients detected by phenotypic and molecular DST. We then developed individualized anti-tuberculosis drug treatment plans for patients with drug-resistant osteoarticular tuberculosis based on DST results, and followed them up for 12 months, comparing a series of prognostic indicators (Imaging, ESR, CRP, VAS) for preoperative and follow-up periods to evaluate the effectiveness of treatment. Measurement data with normal distribution was expressed as “ $\bar{x}$±s”, comparison between groups was tested using ANOVA of repeated measurement data. Non-normal distribution was represented by “Median (IQR)”, comparison between groups was done with Friedman test. Statistically significance was set at P<0.05. Results Among 23 drug-resistant patients who had received individualized treatment for 12 months after surgery, 21 patients got improved, 1 patient had relapsed, and 1 patient was lost to follow-up. The bone graft fusion rate of 21 improved patients was 90.5% (19/21); The average ESR of 21 improved patients before surgery was (62.62±26.52) mm/1 h, the average CRP was (52.29±22.40) mg/L, the average VAS score was 7.0(6.0-7.5) points. After 12 months of personalized treatment, the average ESR dropped to (14.39±5.24) mm/1 h, which was significantly different from that before surgery (t=-8.25,P=0.000); The average CRP was (5.36±2.38) mg/L, had statistically significant difference compared with preoperative period (t=-9.65,P=0.000). Both indicators had returned to the normal range. The average VAS score dropped to 1.0(0.0-1.0)points, showing that symptoms of pain were greatly relieved, and there was a statistically significant difference from the preoperative score (q=7.30,P=0.000). Conclusion Phenotypic DST detection combined with molecular DST detection could help us to rapidly develop a comprehensive anti-tuberculosis drug treatment regimen. Postoperative reasonable and well-followed individualized anti-tuberculosis drug treatment is the key measure to cure osteoarticular tuberculosis.

Key words: Tuberculosis, osteoarticular, Tuberculosis, multidrug-resistant, Microbial susceptibility tests, Drug therapy, Comparative effectiveness research