Abstract
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 score. Methods: 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.
Highlights
Sputum smear and culture examination were used as bacteriological marker to monitor multidrugresistant tuberculosis (MDR-TB) treatment
Multidrug-resistant (MDR)-TB defined as resistance at least to isoniazid (INH) and rifampicin (R) is a major public health problem with an estimated 600 000 new cases reported by the World Health Organization (WHO) in 2016 [1]
For MDR-TB patients who treated by the shorter regime of 9 months, little data are available about the optimal time-to sputum smear or culture conversion, as well as the factors influencing time to sputum bacteriological conversion
Summary
Sputum smear and culture examination were used as bacteriological marker to monitor multidrugresistant tuberculosis (MDR-TB) treatment. Many efforts have been made to validate these MDR-TB treatment efficacy markers including the optimal time of measurement and the influencing factors [2,3,4,5,6,7,8,9,10] One of these studies concluded that the validity of culture conversion is significantly higher than sputum smear conversion, and the four months schedule is a common optimal time for culture and smear conversion [10]. For MDR-TB patients who treated by the shorter regime of 9 months, little data are available about the optimal time-to sputum smear or culture conversion, as well as the factors influencing time to sputum bacteriological conversion. We aimed to identify the strongest contributing factors that affect time to sputum smear and culture conversions, and to develop a practical prognostic risk score
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