PURPOSE To evaluate the sensitivity patterns of anti-tubercular drugs in Xpert MTB-positive spinal tuberculosis (TB) patients and to formulate the guidelines for early start of empiric anti-tubercular treatment (ATT) in MDR-TB spine based on resistance pattern in this large series. METHODS It was a cross-sectional observational study of 252 consecutive patients who were Xpert MTB-proven spinal TB cases with retrospective analysis of prospective data. The Xpert MTB/RIF (Mycobacterium tuberculosis/rifampicin) assay was used to diagnose spinal TB and RIF resistance. All patients underwent drug sensitivity testing (DST) to 13 commonly used anti-tubercular drugs using BACTEC MGIT-960 system. The drug sensitivity pattern of primary and secondary anti-tubercular drugs was recorded and compared. RESULTS The DST study revealed 110 (43.6%) cases of multi-drug resistant (MDR-resistance to both isoniazid and rifampicin) and 24 (9.5%) cases of non-MDR-TB spine. The widespread resistance was found for both isoniazid (91%) and rifampicin (85%), followed by streptomycin (61.9%). The least resistance was found for kanamycin, amikacin and capreomycin and no resistance found for clofazimine. CONCLUSION The Xpert MTB/RIF assay is an efficient technique for the rapid diagnosis of spinal TB and suspected MDR-TB; however, it is recommended to do culture and DST in all patients with spinal TB to guide the selection of appropriate second-line drugs when required. In cases of non-availability of culture and DST, it is suggested to use data from large series such as this to plan the best empirical ATT regimen. These slides can be retrieved under Electronic Supplementary Material.

中文翻译：

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Xpert阳性脊柱结核的药物敏感性模式：252位患者的观察性研究。

目的评估抗Xpert MTB阳性脊柱结核（TB）患者的抗结核药物敏感性模式，并根据耐药模式在MDR-TB脊柱中制定早期开始经验性抗结核治疗（ATT）的指南大系列。方法这是一项横断面观察性研究，对252例经Xpert MTB验证的脊柱结核病例进行回顾性分析。Xpert MTB / RIF（结核分枝杆菌/利福平）测定用于诊断脊髓结核和RIF耐药性。所有患者均使用BACTEC MGIT-960系统对13种常用抗结核药进行了药物敏感性测试（DST）。记录并比较主要和次要抗结核药物的药物敏感性模式。结果DST研究显示110（43。6％）的多药耐药病例（对异烟肼和利福平都有MDR耐药性）和24例（9.5％）非MDR-TB脊柱病例。异烟肼（91％）和利福平（85％），其次是链霉素（61.9％），均发现了广泛的耐药性。卡那霉素，丁胺卡那霉素和卡普霉素的耐药性最小，而氯法齐明没有耐药性。结论Xpert MTB / RIF检测是快速诊断脊柱结核和疑似MDR-TB的有效技术。但是，建议在所有脊柱结核患者中进行培养和DST，以在需要时指导选择合适的二线药物。在无法获得培养物和DST的情况下，建议使用诸如此类的大量数据来计划最佳的经验性ATT方案。这些幻灯片可以在电子补充材料下找到。