Preditores de conversão tardia dos exames micobacteriológicos direto e cultural de expetoração numa população portuguesa com tuberculose pulmonar

Mota, Patrícia Caetano; Carvalho, Aurora; Valente, Iacopo; Braga, Rosana Teresinha Vaccare; Duarte, Raquel

doi:10.1016/j.rppneu.2011.12.005

Cited by 27 publications

(17 citation statements)

References 23 publications

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“…We found higher initial smear grading which was associated with delayed conversion time ( P = 0.01). This finding was observed in previous studies [ 7 , 14 , 15 , 17 ].…”

Section: Discussionsupporting

confidence: 91%

“…Treatment outcomes in patients with TB and DM have been a subject of debate. In a study performed in India smear conversion was similar in diabetic and nondiabetic patients [ 17 ], in contrast to another study conducted in México which identified diabetes as an independent risk of failure to treatment [ 19 ]. Defects in the immune system of patients with active TB and DM have been reported, including reductions in the activation of alveolar macrophages and the capacity to produce interleukin [ 20 , 21 ], in addition to some degree of impaired limited numbers of diabetic patients' gastrointestinal drug absorption even in the absence of clinical gastroparesis [ 22 ].…”

Section: Discussionmentioning

confidence: 97%

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Five-Year Assessment of Time of Sputum Smears Conversion and Outcome and Risk Factors of Tuberculosis Patients in Central Iran

Behnaz

Mohammadzadeh

Mohammadzade

2015

Tuberculosis Research and Treatment

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Objective. To evaluate risk factors which influence sputum smear conversion, outcome, and trends of conversion of sputum smear during 5 years and compare outcomes in patients with different regimens. Methods. In a retrospective cohort study, all patients with sputum smear positive tuberculosis were evaluated for comorbidities and demographic, microbiological, and therapeutic data and outcome. Smear examinations were performed at the beginning, at 2 months for CAT I, at 3 months for CAT II, at the end of second month of maintenance phase, and at the end of treatment. Results. This study enrolled 211 sputum smear positive patients, but 189 patients who completed the intensive phase of treatment were evaluated. Sputum smear of 158 patients converted at the end of intensive phase (83.6). Univariate analysis indicated that the risk of a persistent positive smear at the end of intensive phase was greater in diabetic patients ((odds 4.038, 95% CI 1.123–14.516) P = 0.033), and also a 3+bacillary load had risk of 2.933-fold ((95% CI 1.278–6.732) P = 0.011). Overall rate of unfavorable outcome was 20.9%. Factors associated with unfavorable outcome were age (P value 0.000), male gender (P value 0.027), diabetes (P value 0.000), and delayed conversion of sputum at the end of intensive phase (P value 0.000). Outcome for different regimens was not different significantly. Two specimens were isoniazid resistant. Conclusions. We suggest supervised treatment and care for diabetic patients and those with higher bacillary load. Paying attention to early diagnosis of tuberculosis in the elderly to reduce poor outcome and further measures to prevent transfer-out could improve the success rate.

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“…We found higher initial smear grading which was associated with delayed conversion time ( P = 0.01). This finding was observed in previous studies [ 7 , 14 , 15 , 17 ].…”

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Five-Year Assessment of Time of Sputum Smears Conversion and Outcome and Risk Factors of Tuberculosis Patients in Central Iran

Behnaz

Mohammadzadeh

Mohammadzade

2015

Tuberculosis Research and Treatment

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“…Twenty-four percent of the patients who received extended treatment had delay of sputum smear and culture conversion longer than 2 months. This outcome well corresponded with results of several epidemiological studies indicating that the proportion of TB patients who remain smear-positive after 2 months of treatment can be greater than 20% (3.3–25.3%) [39–48]. However, our multivariable regression analysis did not confirm significant differences in delay of culture conversion between our two groups.…”

Section: Discussionsupporting

confidence: 91%

Predictors of Prolonged TB Treatment in a Dutch Outpatient Setting

Boveneind-Vrubleuskaya

Daskapan

Kosterink

et al. 2016

PLoS ONE

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IntroductionStandard treatment duration for drug-susceptible tuberculosis (TB) treatment is 6 months. Treatment duration is often extended—and for various different reasons. The aim of this study was to determine the prevalence and to assess risk factors associated with extended TB treatment.MethodsA cross-sectional study was conducted. Data including demographic, clinical, radiological and microbiological information from the Netherlands TB Register (NTR) of 90 patients with smear and culture positive pulmonary TB of the region Haaglanden, The Netherlands, was eligible for analysis.ResultsTreatment was extended to ≥ 200 days by 46 (51%) patients. Extended TB treatment was associated with a higher frequency of symptoms, presumed to be due to adverse drug reactions (ADR; OR 2.39 95% CI: 1.01–5.69), drug-induced liver injury (DILI) (OR: 13.51; 95% CI: 1.66–109.82) and longer than 2 month smear and culture conversion rate (OR: 11.00; 95% CI: 1.24–97.96 and OR: 8.56; 95% CI: 1.53–47.96). In the multivariable logistic analysis, development of DILI emerged as the single statistically strong risk factor necessitating extension of TB treatment.ConclusionThis finding will need further confirmation in a prospective study, exploring the possible mutual role of pharmacokinetic and pharmacogenetic determinants of DILI among TB patients.

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“…Caetano Mota et al reported that patients with a high pre-treatment colony count were less likely to convert than patients with a low pre-treatment colony count. [ 5 ] In the present study, although sputum smear grading, which is available at an early time point of treatment, was chosen as an index of bacillary load, the result is similar to that of the previous report. It may be natural that patients with a higher colony count take a longer time to convert sputum cultures.…”

Section: Discussionmentioning

confidence: 55%

“…Sputum culture conversion after the first 2 months of treatment is recognized as a surrogate biomarker of long-term cure. [ 2 , 3 ] It has been reported that the presence of cavitation [ 4 ], the extent of the disease [ 5 , 6 ] on chest X-ray (CXR), high colony count, [ 5 ] diabetes mellitus, [ 6 ] and smoking [ 4 , 7 – 9 ] are associated with culture non-conversion after the first 2 months of treatment. However, no study has evaluated which factors affect the time to sputum culture conversion throughout the course of treatment in a cohort without any censored cases.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases

et al. 2015

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BackgroundIn patients with pulmonary tuberculosis (TB), shortening the time to sputum culture conversion is desirable to reduce the likelihood of mycobacterial transmission. A persistent positive sputum culture after 2 months of treatment is reported to be associated with the presence of cavitation and the extent of disease on chest X-ray, high colony count, diabetes mellitus, and smoking. However, little is known about factors affecting the time to sputum culture conversion. This study was conducted to evaluate factors affecting the time to sputum culture conversion throughout the course of treatment in adults with pulmonary TB.MethodsThis study was performed using a database of the medical records of patients with active pulmonary TB who were treated at Hirakata Kohsai Hospital in Hirakata City, Osaka, Japan, from October 2000 to October 2002. Cox proportional-hazards analysis was used to evaluate factors affecting the time to sputum culture conversion after adjusting for potential confounders.ResultsThe data of 86 patients with pulmonary TB were analyzed. The median time to sputum culture conversion was 39 days, and the maximum time was 116 days. The Cox proportional-hazards analysis showed that a higher smear grading (HR, 0.40; 95%CI, 0.23–0.71) and a history of ever smoking (HR, 0.48; 95%CI, 0.25–0.94) were associated with delayed sputum culture conversion.ConclusionHigh smear grading and smoking prolonged the time to sputum culture conversion in adults with pulmonary TB. To effectively control TB, measures to decrease the cigarette smoking rate should be implemented, in addition to early detection and timely anti-TB treatment.

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Preditores de conversão tardia dos exames micobacteriológicos direto e cultural de expetoração numa população portuguesa com tuberculose pulmonar

Cited by 27 publications

References 23 publications

Five-Year Assessment of Time of Sputum Smears Conversion and Outcome and Risk Factors of Tuberculosis Patients in Central Iran

Five-Year Assessment of Time of Sputum Smears Conversion and Outcome and Risk Factors of Tuberculosis Patients in Central Iran

Predictors of Prolonged TB Treatment in a Dutch Outpatient Setting

Factors Affecting Time to Sputum Culture Conversion in Adults with Pulmonary Tuberculosis: A Historical Cohort Study without Censored Cases

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