Time for culture conversion and its associated factors in multidrug-resistant tuberculosis patients at a tertiary level hospital in Peshawar, Pakistan.

Zafar Iqbal,Aamir Aziz,Syed Muhammad Nasir,Mazhar Ali Khan

doi:10.12669/pjms.38.4.5058

Abstract

Objectives:This study aimed to assess the time to sputum culture conversion (SCC) and its determinants among multidrug-resistant tuberculosis (MDR-TB) patients.Methods:This cross-sectional study was conducted from January 2019 to January 2020. A total of 252 MDR-TB patients presenting at a tertiary level teaching hospital in Peshawar, Khyber Pakhtunkhwa (KP), were included. The patient’s demographic and clinical data were collected using a structured questionnaire. Time to SCC was calculated from the initiation of treatment till the patient had two consecutive negative cultures. The Cox proportional-hazards analysis was performed to check strength and association between the determinants and time for SCC.Results:Out of 252 MDR-TB patients enrolled, sputum culture conversion was observed in 76.6% of the patients by the end of six months. While, 19.0% of the patients failed to achieve negative culture and remained positive after interim report of their treatment. Age > 45 years (HR = 15.22; 95% CI: 7.27-31.83; p<0.001), female gender (6.22; 2.90-13.36; p<0.001), BMI < 18.5 kg/m2 (10.28; 5.25-20.11; p<0.001), weight loss (0.03; 0.01-0.06; p<0.001), smoking (0.10; 0.05-0.21; p<0.001), diabetes mellitus (0.02; 0.00-0.04 p<0.001) and disease severity on chest X-ray (CXR) (0.03; 0.01-0.09; p<0.001) were the significant determinants of delayed sputum culture conversion.Conclusion:MDR-TB patients with older age, low BMI, weight loss, diabetes, smokers and those with disease severity on CXR are less likely to respond to treatment as they displayed delayed SCC. Therefore, such patients should be meticulously followed up for successful management.

Highlights

Tuberculosis (TB) is an infectious disease striking all the efforts for better health throughout the world from ancient times and still prevails.[1]
Pak J Med Sci March - April 2022 (Part-II) Vol 38 No 4 www.pjms.org.pk 1009 the Centre for Disease Control & Prevention (CDC), the incidence rate of TB has declined by an average of 2% to 3% annually, i.e. from 2.7 during 2019 to 2.2 per 100,000 persons in 2020.2 Still, this deadly disease accounts for 1.6 million deaths per year, which is substantially contributed by human immunodeficiency virus (HIV)/Acquired immunodeficiency syndrome (AIDS).[3]
252 multidrug-resistant tuberculosis (MDR-TB) patients were included from different areas of Khyber Pakhtunkhwa, the Ex-FATA region and Afghanistan

Summary

Introduction

Tuberculosis (TB) is an infectious disease striking all the efforts for better health throughout the world from ancient times and still prevails.[1]. It is one of the world’s most widespread and deadly illnesses caused by inhaled airborne droplet nuclei containing viable organisms, characterized by slowly progressive constitutional symptoms of malaise, anorexia, weight loss, fever, night sweats and often presents with chronic cough and blood-streaked sputum. According to National TB control program, the reported mortalities among TB patients is 34 per 100,000 population per year.[5]. This death rate, despite seeking medical care, reflects the inadequacy of the healthcare system.[6]

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