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academies
International Surgery and Ortho Conference
October 25-26, 2017 | Toronto, Canada
Case Rep Surg Invasive Proced 2017 | Volume 1 Issue 3
Xpert MTB/RIF assay and early diagnosis of multi-drug resistant tubercular spondylodiscitis
Justin Arockiaraj
Christian Medical College and Hospital, India
Introduction:
According toWHO global report 2015, India ranks
second largest country in terms of number of Tuberculosis
patients. Though TB of the spine accounts for <1%, with the
emergence of multidrug drug resistance makes it a challenge to
medical field. It ismandatory to detect early and tomake proper
management plans in terms of chemotherapy. Few papers
have reported about drug resistant tuberculosis. The aim is to
evaluate the role of Xpert MTB/RIF assay in early detection of
multi-drug resistant tubercular spondylodiscitis.
Patients & Methods:
This is a retrospective study conducted
from2006 to 2013 in our tertiary care center on all patients who
were treated for tubercular spondylodiscitis. Only culture/Xpert
MTB/RIF assay positive patients were included in the study.
Their demographic profile, type of MDR, diagnostic criteria,
medications, drug related complications and cost per patient
analysis was done. All MDR patients were treated with five drug
regimens for a period of 24 months as per drug susceptibility
tests and WHO recommendations. The outcome parameters
analyzed included clinical, bio-chemical and radiological criteria
to assess healing status.
Results:
During this study period (7 years), total of 561 patients
were treated for tubercular spondylodiscitis. 36 of them had
Multi-drug resistant tubercular spondylitis (prevalence-6.4%)
and 3 had extremely drug resistant tubercular spondylitis
(prevalence -0.5%) proven by culture and or Xpert MTB/Rif
assay. One patient died due to septicemia and five were lost to
followup. 30 patients withmean age of 29 years andwithmean
post-treatment follow up of 24 months were enrolled. 77% had
secondary MDR. 17 (56%) patients underwent surgery and the
rest had biopsy for diagnosis. Among those patients who had
surgery, 60% of the patients had neurological deficit. 26 (87%)
patients had completed two years of therapy and were healed
and rest four were still on MDR treatment. Analysis of Xpert
MTB/RIF assay showed 100% sensitivity and 92.3% specificity to
detect rifampicin resistance. Drug related complications (33%)
included ototoxicity, hypothyroidism and hyperpigmentation of
skin. The cost per patient analysis for MDR patient showed 70
times increase when compared to that of conventional 1st line
anti-tuberculous chemotherapy.
Conclusions:
In conclusion, prevalence of MDR tubercular
spondylodiscitis is 6.4%, the sensitivity and specificity of
GeneXpert test to detect MDR is 100% and 92.3% respectively.
10 patients (33%) had drug related complications. The cost of
drugs for MDR tubercular spondylodiscitis is 70 times more
than that of 1st line ATT for conventional tuberculosis.
Speaker Biography
I have completed my undergraduate (MBBS) and post graduate training (D. Ortho.,
M.S. Ortho., DNB Orthopaedics) in the field of Orthopaedics, at the Christian Medical
College and Hospital, Vellore, India. I am currently working as an Associate Professor
in the Spinal Disorder Surgery unit, Department of Orthopaedics. I am interested in
academics and teaching. I am a resource person for Distance Education Program and
Post graduate Diploma in Family Medicine. I regularly take classes for under graduate
students, post graduate students and spine fellows. Tuberculosis is one among my
favorite topics. I have couple of publications both in national and international journals.
e:
svjustin.arockiaraj@gmail.com