Sputum bacteriology conversion and treatment outcome of patients with multidrug-resistant tuberculosis

Abstract

PurposeMultidrug-resistant tuberculosis (MDR-TB) requires long-term treatment, has a high fatality rate, and constitutes a global threat. Earlier detection of treatment failure is required to predict therapeutic efficacy.Patients and methodsWe enrolled MDR-TB patients consecutively from January 2011 through December 2012 in Lianyungang, China. Sputum smear microscopy tests and sputum cultures were performed once a month for the first 6 months following initiation of antituberculosis treatment and once every 2 months thereafter until the end of therapy. The sensitivity, specificity and area under the receiver operating characteristic curve (AUC) were used with a 95% CI to estimate the role of sputum bacteriology conversion in predicting treatment outcomes.ResultsAmong the 92 MDR-TB patients enrolled in this study, 40.2% had poor treatment outcomes. The median initial sputum bacteriology conversion time was 1 month. Patients having 2-month sputum smear conversions (adjusted odds ratio [OR]: 7.19, 95% CI: 2.60–19.84) or culture conversions (adjusted OR: 2.88, 95% CI: 1.11–7.45) were more likely to experience good outcomes. The sensitivity and specificity obtained when using two-month sputum smear conversions to predict treatment outcomes were 67.6% (95% CI: 50.2–82.0) and 76.4% (95% CI: 63.0–86.8), respectively. The sensitivity and specificity obtained when using 2-month culture conversions to predict treatment outcomes were 48.6% (95% CI: 32.0–65.6) and 74.5% (95% CI: 61.0–85.3), respectively. The AUC for two-month smear conversions was 0.72 (95% CI: 0.62–0.81), significantly higher than that obtained for 2-month culture conversions (0.62, 95% CI: 0.52–0.72) (χ2 = 4.18, P = 0.041).ConclusionThe prognoses of MDR-TB patients displaying persistent sputum positivity were inferior to those for whom sputum bacteriology conversion was observed. Thus, sputum smear conversion results obtained 2 months after treatment initiation may provide a potential means for predicting MDR-TB treatment outcomes.

<p>Predictors of Time to Sputum Culture Conversion Among Drug-Resistant Tuberculosis Patients in Oromia Region Hospitals, Ethiopia</p>

“…The four-month conversion rate is higher than the study conducted in Latvia (60%). 28 The two-month culture conversion rate in this study was 46.9% which is much lower than the study conducted in Seoul (90.1%) 42 China (65.2%) 47 and Germany (61%), 43 but higher than reported finding from Chinese study (33.3%). 38 The difference in the culture conversion rate among different study sites might be related to a difference in treatment protocol followed in different sites, the difference in the study population, type of drug resistance, and the difference in the quality of reported data.…”

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

“…The high SCC rate was concordant with the treatment success rate among participants in this study, which was the highest ever reported in a domestic study (20)(21)(22) and relatively high globally (6,(23)(24)(25)). This, combined with the declining drug resistance rates among pulmonary tuberculosis patients during 2011-2015 in Hangzhou, e.g.…”

Treatment outcomes of multidrug-resistant tuberculosis in Hangzhou, China, 2011 to 2015

“…To our knowledge, this was the highest treatment success rate of MDR-TB patients to be reported in mainland China. [ 19 – 22 , 25 , 26 ] This marks Hangzhou as the first Chinese city to achieve the WHO target of 75% treatment success. [ 27 ] Treatment success rates reported in other Chinese cities were all under 70%, [ 19 – 21 , 25 , 26 , 28 , 29 ] and the cure rate ranged from 50% to 60%.…”

“…[ 19 – 22 , 25 , 26 ] This marks Hangzhou as the first Chinese city to achieve the WHO target of 75% treatment success. [ 27 ] Treatment success rates reported in other Chinese cities were all under 70%, [ 19 – 21 , 25 , 26 , 28 , 29 ] and the cure rate ranged from 50% to 60%. [ 30 , 31 ] Our study reaffirms a previous study that showed Hangzhou as having a higher MDR-TB treatment success rate (73.7%) than other areas of China.…”