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Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients



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.


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.


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.


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.

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  1. 1.

    WHO (2010) Multidrug and extensively drug-resistant TB (M/XDR-TB): global report on surveillance and response Geneva. who/htm/tb/2010.3

  2. 2.

    Polley P, Dunn R (2009) Noncontiguous spinal tuberculosis: incidence and management. Eur Spine J 18:1096–1101

  3. 3.

    Arora S, Kumar R (2011) Tubercular spinal epidural abscess involving the dorsal lumbar- sacral region without osseous involvement. J Infect Dev Ctries 5:544–549

  4. 4.

    Stop Tuberculosis Department (2008) Guidelines for the programmatic management of drug-resistant tuberculosis: emergency update. WHO, Geneva. who/htm/tb/2008.402

  5. 5.

    Pawar UM, Kundnani V, Agashe V et al (2009) Multi drug resistant tuberculosis of spine: is it the beginning of the end? Spine 34(22):E806–E810

  6. 6.

    WHO (2011) The global plan to stop TB 2011–2015: transforming the fight towards elimination of tuberculosis.

  7. 7.

    WHO (2009) Treatment of tuberculosis: guidelines, 4th edn. Geneva. who/htm/tb/2009.420

  8. 8.

    WHO (2008) Anti-tuberculosis drug resistance: report no. 4, The WHO/IUALTD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. Geneva. who/htm/tb/2008.394:1-142

  9. 9.

    WHO (2006) Guidelines for the programmatic management of drug resistant tuberculosis. Geneva. who/htm/tb/2006.361

  10. 10.

    Mohan K, Rawall S, Pawar UM et al (2012) Drug resistance patterns in 111 cases of drug-resistant tuberculosis spine. Eur Spine J 22:647–652

  11. 11.

    World Health Organization (2017) WHO endorses new rapid tuberculosis test. Accessed 18 Sept 2017

  12. 12.

    World Health Organization (2009) Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extra pulmonary. WHO (2009) Treatment of tuberculosis: guidelines, 4th edn. Geneva. who/htm/tb/2009.420

  13. 13.

    Held M, Laubscher M, Zar HJ (2014) Dunn RN (2014) GeneXpert polymerase chain reaction for spinal tuberculosis: an accurate and rapid diagnostic test. Bone Joint J 96-B(10):1366–1369

  14. 14.

    Gu Y, Wang G, Dong W et al (2015) Xpert MTB/RIF and GenoType MTBDR plus assays for the rapid diagnosis of bone and joint tuberculosis. Int J Infect Dis 36:27–30

  15. 15.

    Xpert MTB RIF kit insert (2015).

  16. 16.

    Udwadia ZF (2001) India’s multi-drug resistant tuberculosis crisis. Ann NY Acad Sci 953:98–105

  17. 17.

    Schaaf HS, Shean K, Donald PR (2003) Culture confirmed multidrug resistant tuberculosis: diagnostic delay, clinical features and outcome. Arch Dis Child 88(12):1106–1111

  18. 18.

    Singh A (2007) XDR-TB: Indian perspective. Eur Respir J 30:178–179

  19. 19.

    Suarez-Garcia I, Rodriguez-Blanco A, Vidal-Perez JL, Garcia-Viejo MA, Jaras-Hernandez MJ et al (2009) Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain. Eur J Clin Microbiol Infect Dis 28(4):325–330

  20. 20.

    Caminero JA (2006) Treatment of multidrug resistant tuberculosis: evidence and controversies. Int J Tuberc Lung Dis 10(8):829–837

  21. 21.

    Crofton J, Chaulet P, Maher D (1997) Guidelines for the management of drug resistant tuberculosis. Geneva 1997. WHO/TB/96:210

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Correspondence to Jwalant Patel.

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Upadhyay, M., Patel, J., Kundnani, V. et al. Drug sensitivity patterns in Xpert-positive spinal tuberculosis: an observational study of 252 patients. Eur Spine J (2020).

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  • Spinal tuberculosis
  • MDR-TB
  • Xpert MTB/RIF
  • Drug sensitivity testing
  • Anti-tubercular drugs
  • Second-line drugs