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Abstract：
BACKGROUND: 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 Mycobacterium tuberculosis with no non-tubercular Mycobacterium. 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.
摘要：
背景：本研究旨在确定流行区患者对抗结核药物耐药的发生率。方法：40例连续经临床放射学诊断的骨关节结核患者（29：脊柱，11：脊柱外）入选。31例取针吸脓液，脊柱减压后的组织在7年，滑膜合二为一，和鼻窦边缘活检合二为一。脓液/组织进行抗酸杆菌(AFB)染色和液体培养,对13种抗结核药物(异烟肼(异烟肼)，利福平（RIF），卡那霉素（KAN），阿米卡星（AMK，)卷曲霉素(CAP)，乙硫酰胺（ETH），左氧氟沙星（LEV），莫西沙星（MOX），利奈唑胺（LNZ），对氨基水杨酸（PAS），bedaquiline(BDQ),德拉曼尼德(DLM)，和氯法齐明(CFO)进行了检查，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；21名女性，19名男性。AFB涂片对结核病的诊断准确率为20%，65%的液体培养，组织病理学82.5%，和90％通过基于盒的核酸扩增测试（CBNAAT）。所有培养阳性的分离株都被鉴定为结核分枝杆菌，没有非结核分枝杆菌。CBNAAT的耐药性为11.1%,线探针测定（LPA）一线为15.4%，LPA二线为4%，液体药敏试验(DST)11.5%。我们检测到15.4%的异烟肼抗性，11.1%RIF，7.6%LEV,3.8%MOX和PAS。没有检测到对二线注射药物（SLID）的耐药性，ETH,LNZ,BDQ,DLM,CFO结论：没有单一的实验室模式可以确定所有病例的诊断；因此，样品应同时发送进行所有测试。在样品不足的情况下，可以对组织进行CBNAAT和组织病理学以达到组织诊断。在这个子集中，总体耐药发生率为12.5%（5/40），其中1例患者均有单独的INH和RIF耐药，一种多药耐药(MDR)，和两个前广泛耐药（前XDR）。原发性耐药性为11.1％（4/36），各一名患者对INH和RIF耐药，MDR之一，和一个前XDR。
