Abstract
Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999-2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15-30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.
Highlights
Tuberculosis (TB) has been a serious infectious disease in developing countries, and spinal TB is the most common bone and joint TB, accounting for about 50% of cases [1]
The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of multi-drug resistant (MDR) spinal TB treatment, improved infection control and better clinical outcome
We found that MDR spinal TB patients aged over 51 years have a higher proportion than spinal TB without MDR
Summary
Tuberculosis (TB) has been a serious infectious disease in developing countries, and spinal TB is the most common bone and joint TB, accounting for about 50% of cases [1]. According to a 2018 research report by the World Health Organization (WHO) [3], 10 million people worldwide developed TB disease in 2017 and there was an estimated 1.6 million TB patients deaths at the same year. Drug resistant tuberculosis (DR-TB) is becoming more serious [4].The latest global TB report 2018 pointed out that the number of new TB patients in China reached 889 000, of which DR-TB accounted for 7.1% [3]. Current diagnostic imaging devices provide additional information, diagnosis and treatment still face challenges due to the slow progress in clinical features, which lead to neurological complications and spinal deformities. Diagnosis and treatment are the key to avoiding this chronic disability
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