Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China

Li, Qiao; Lü, Peng; Martínez, Leonardo; Huang, Yang; Lü, Wei; Ding, Xiaoyi; Zhu, Limei

doi:10.1186/s12879-018-3021-0

Cited by 35 publications

(53 citation statements)

References 28 publications

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“…However, further research should investigate the validity of SCC at different timepoints as an early predictor of treatment efficacy, as it may differ by regions with different HIV prevalence, capacities for MDR-TB treatment, and drug resistance patterns (12,13). For example, the 6-month SCC had stronger association with cure than 4-month SCC among Pakistan patients (7), while studies conducted in China and Ethiopia showed that the optimum time point of achieving SCC for predicting successful treatment outcome was between four to six months (26).…”

Section: Discussionmentioning

confidence: 99%

“…Elucidating potential predictors of SCC in MDR-TB could help identify patients who are likely to develop poor outcomes and prompt clinical intervention to improve treatment outcomes for these individuals. Numerous studies have been conducted to investigate the predictors for MDR-TB treatment outcomes (11)(12)(13), but few have been carried out in China. We therefore designed a retrospective cohort study to evaluate the SCC and identify its predictors among MDR-TB patients in Hangzhou in eastern China.…”

Section: Introductionmentioning

confidence: 99%

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Time to sputum culture conversion and its predictors among patients with multidrug resistant tuberculosis in Hangzhou, China: a retrospective cohort study

Hsieh

et al. 2019

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Background To investigate the time to initial sputum culture conversion (SCC) and its predictors among multidrug-resistant tuberculosis (MDR-TB) patients in Hangzhou, China.Methods A retrospective cohort study was conducted among patients initiating treatment for MDR-TB from 2011-2015 in Hangzhou, China. Time to initial SCC was analyzed using the Kaplan-Meier method, and Cox proportional hazards regression was used to identify predictors of SCC.Results Among 384 patients enrolled with MDR-TB, 359 (93.5%) successfully achieved initial SCC after a median of 85 days (inter-quartile range, 40-112 days). A higher rate of SCC was observed in participants with successful treatment outcomes than those with poor treatment outcomes (P<0.01). Multivariate analysis showed that age 25-64 years (adjusted odds ratio [AOR], 0.7; 95% confidence interval [CI], 0.5-0.9; P<0.01), age ≥65 years (AOR, 0.5; 95%CI, 0.3-0.8; P<0.01) and household registration in Hangzhou (AOR, 1.3; 95%CI, 1.0-1.5; P<0.05) were found to be associated with SCC.Conclusions Although high SCC and treatment success rates were observed among MDR-TB patients in Hangzhou, the prolonged duration to initial SCC underscores the importance of emphasizing measures for infection control. A new policy of shifting outpatient treatment to inpatient treatment in China may reduce the risk of transmission from patients in the time window prior to SCC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Time to sputum culture conversion and its predictors among patients with multidrug resistant tuberculosis in Hangzhou, China: a retrospective cohort study

Hsieh

et al. 2019

Preprint

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“…Sputum conversion plays an important role in the management of tuberculosis because it determines response to TB treatment [6,7] . Prognosis of the patient is determined by negativity or positivity of the sputum results.…”

Section: Introductionmentioning

confidence: 99%

Multidrug resistant tuberculosis conversion rate after initiation on standardised short regimen: Retrospective study

Somfongo¹,

Mupindu²,

Mangi³

2020

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Background Multi Drug Resistance (MDR) Tuberculosis (TB) is a global risk. Several suboptimal results were noticed which resulted to introduction of a standardised short regimen of 9-12 to optimise favourable outcomes. This new intervention has not been evaluated for effectiveness since inception in the Eastern Cape Province. Objective: T o evaluate multidrug resistant tuberculosis conversion rate following initiation on short regimen. Methods A retrospective study using a descriptive design was used to collect data from conveniently sampled 71 documents at Nkqubela TB and Duncan Village Day hospitals. Data were collected using a self-designed structured questionnaire and analysed using Statistical Packages for Social Sciences (SPSS) version 24. Results Sixteen percent (n=19) of 71 records had no consecutive smear results. Demographic findings showed that the majority of the affected age group was between the ages of 36-45 years in both genders (34.7%, n=47) with males being highly affected more than females. The majority of participants were unemployed (51.7%), people living with HIV/AIDS (62.7%), use alcohol and smoking. Conversion rate was 68, 5%. Conclusion There is a need to review EDR web to accommodate sputum results irrespective of TB treatment start date. An extensive, ongoing counselling, support and health education needs to be provided for patients and families until the completion of treatment to emphasize the importance of monthly sputum collection and importance of treatment adherence. Clinicians need to strengthen their counselling and education skills. The introduction of short regimen to treat MDR has shown an improved sputum conversion rate in RR/MDR TB.

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“…Regardless the MDR-TB treatment regime (12 or 24 months), the WHO recommend the using sputum smear or culture conversion as a proxy marker for a successful MRD-TB treatment outcome [1]. Recently, many efforts have been made to validate these MDR-TB treatment e cacy markers including the optimal time of measurement and the in uencing factors [2][3][4][5][6][7][8][9][10]. One of these studies concluded that the validity of culture conversion is signi cantly higher than sputum smear conversion, and the four months schedule is a common optimal time for culture and smear conversion [10].…”

Section: Introductionmentioning

confidence: 99%

“…One of these studies concluded that the validity of culture conversion is signi cantly higher than sputum smear conversion, and the four months schedule is a common optimal time for culture and smear conversion [10]. Nevertheless, the in uencing factors of time-to initial sputum smear and culture conversions varied from one study to another [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Risk score to predict time-to sputum smear and culture conversions in patients treated with shorter MDR-tuberculosis regime in Guinea (Conakry): A retrospective cohort study.

Diallo

Camara

et al. 2019

Preprint

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Background Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk scoreMethods Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion.Results 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59 – 61) respectively. Lower colony count (< 3 +) of initial culture (aHR = 1.52, 1.09 – 2.14) and previously history of TB treatment (aHR = 2.10, 1.26 – 3.51) were more likely to have culture conversion, while only the higher BMI (aHR = 1.10, 1.03 – 1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855 ± 0.023 and 0.883 ± 0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months.Conclusion The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime. Keywords: Conversion, Multidrug-resistant, Tuberculosis, Guinea.

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Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China

Cited by 35 publications

References 28 publications

Time to sputum culture conversion and its predictors among patients with multidrug resistant tuberculosis in Hangzhou, China: a retrospective cohort study

Time to sputum culture conversion and its predictors among patients with multidrug resistant tuberculosis in Hangzhou, China: a retrospective cohort study

Multidrug resistant tuberculosis conversion rate after initiation on standardised short regimen: Retrospective study

Risk score to predict time-to sputum smear and culture conversions in patients treated with shorter MDR-tuberculosis regime in Guinea (Conakry): A retrospective cohort study.

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