Global and Regional Patterns of Drug Resistance and Treatment Regimens in Spinal Tuberculosis: A Systematic Review and Meta-Analysis
Abstract
Study DesignSystematic review and meta-analysis.ObjectiveTo evaluate the prevalence, patterns, diagnosis, and management of drug-resistant spinal tuberculosis (TB).MethodsWe systematically searched PubMed, Embase, Scopus, Web of Science, and the Cochrane database from database inception to 14 February 2026, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Observational and experimental studies reporting drug resistance among patients with spinal TB were included. A random-effects meta-analysis was performed to estimate pooled proportions with 95% confidence intervals (CI). Risk of bias was assessed using the Joanna Briggs Institute checklist.ResultsNineteen studies involving 5,475 patients with spinal TB were included. The pooled prevalence of multidrug-resistant (MDR)-TB among spinal TB was 4.69% (95% CI: 3.03-7.20%; 16 studies). Rifampicin resistance was noted in 13.84% (95% CI: 3.07-44.90%; 6 studies). Drug susceptibility testing was most commonly performed after clinical or radiological non-response rather than as routine practice. Treatment approaches were heterogeneous, with MDR spinal TB typically managed using individualized second-line anti-TB regimens, frequently combined with surgical intervention. Low risk of bias was documented in 47.4% of studies.ConclusionsThe prevalence of MDR-TB among spinal tuberculosis was 4.69%. Considerable heterogeneity exists in drug susceptibility testing, diagnosis, medical…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 5,475 participants or records.
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