Improvement in clinical outcome and infection control using molecular diagnostic techniques for early detection of MDR tuberculous spondylitis: a multicenter retrospective study

There has been limited research on the therapeutic efficacy of molecular diagnosis of spinal tuberculosis. We attempted to determine whether the utilization of molecular diagnosis to detect multidrug-resistant spinal tuberculosis can improve clinical outcomes. A multicenter retrospective study was conducted from February 2009 to June 2015. Ninety-two consecutive culture-confirmed multidrug-resistant tuberculosis (MDR-TB) patients with spinal tuberculosis who were diagnosed clinically and by imaging were enrolled in the study. The initial time to treatment for MDR-TB, the method of infection control, the erythrocyte sedimentation rate (ESR) and the occurrence of complications in patients who were diagnosed using molecular methods were compared with those of patients diagnosed using standard culture and drug susceptibility test methods. Of 92 MDR-TB patients with spinal tuberculosis, 41 (45%) were diagnosed by standard culture and drug susceptibility test methods (Group A), and 51 (55%) were diagnosed following implementation of detection using molecular diagnosis (Group B). The patients in Group B began the rational use of second-line drugs earlier than patients in Group A (5 days vs 73 days, P<0.05). Among patients who were admitted to a general tuberculosis ward, those in Group B spent less time in the ward than those in Group A (4 days vs 33 days, P<0.05). At the one-month follow-up, the ESR was significantly lower in Group B. In patients who completed 6 months of follow-up (n=92), the incidence of complications was significantly lower in Group B. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR-TB treatment, improved infection control, better clinical outcome, a more rapid decrease in ESR and fewer complications.