Prevalence and associated factors of delayed sputum smear conversion in patients treated for smear positive pulmonary tuberculosis: A retrospective follow up study in Sabah, Malaysia

Abstract

Introduction Tuberculosis remains a major health problem globally and in Malaysia, particularly in the state of Sabah. Delayed sputum conversion is associated with treatment failure, drug-resistant tuberculosis and mortality. We aimed to determine the prevalence of delayed sputum conversion among smear positive pulmonary tuberculosis (PTB) patients and its associated factors in Sabah, Malaysia. Methods A retrospective follow up study on all patients newly diagnosed with smear positive pulmonary tuberculosis from 2017 to 2019 was conducted at three government health clinics in Sabah, utilizing data from a national electronic tuberculosis database and medical records. Descriptive statistics and binary logistic regression were applied for data analysis. The outcome of the study was the sputum conversion status at the end of the two-month intensive treatment phase with either successful conversion to smear negative or non-conversion. Results 374 patients were included in the analysis. Our patients were generally younger than 60 years old with no medical illness and varying proportions of tuberculosis severity as judged by radiographic appearance and sputum bacillary load upon diagnosis. Foreigners constituted 27.8% of our sample. 8.8% (confidence interval: 6.2–12.2) did not convert to smear negative at the end of the intensive phase. Binary logistic regression showed that older patients ≥60 years old (adjusted odds ratio, AOR = 4.303), foreigners (AOR = 3.184) and patients with higher sputum bacillary load at diagnosis [2+ (AOR = 5.061) and 3+ (AOR = 4.992)] were more likely to have delayed sputum smear conversion. Conclusion The prevalence of delayed sputum conversion in our study was considerably low at 8.8% with age ≥60 years old, foreigners and higher pre-treatment sputum bacillary load associated with delayed conversion. Healthcare providers should take note of these factors and ensure the patients receive proper follow up treatment.

A Study on Factors Influencing Delayed Sputum Conversion in Newly Diagnosed Pulmonary Tuberculosis Based on Bacteriology and Genomics

“…This study examines the microbiological conversion time and treatment outcomes in 1782 patients, revealing a signi cant correlation between microbiological conversion after two months of ATT and nal cure, which aligns with previous reports [5][6][7]27 . Differing from existing research perspectives about factors affecting sputum conversion 12,13,27,28 , we provide an innovative and comprehensive information on bacteriology and genomics of MTB.…”

Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus

“…The primary treatment of a new case of APTB - defined as a patient in whom the diagnosis of pulmonary tuberculosis has been established for the first time or if treatment was received for less than 30 days - should include monthly follow-up with sputum smear microscopy until the end of treatment [ 11 ]. This follow-up is essential for the clinical control of the disease, and in adults, it is performed through microscopic examination of sputum [ 12 , 13 ]. While this test is simple, rapid, and low-cost, its low sensitivity limits its usefulness as a tool for monitoring the treatment outcome of patients with APTB [ 14 , 15 ].…”