Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study
The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment suc...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
PAGEPress Publications
2021-01-01
|
| Series: | Monaldi Archives for Chest Disease |
| Subjects: | |
| Online Access: | https://monaldi-archives.org/index.php/macd/article/view/1675 |
| _version_ | 1819241201339990016 |
|---|---|
| author | Saulius Diktanas Oleksandr Korotych Yuliia Sereda Ogtay Gozalov Olga Rubcova Jay Achar |
| author_facet | Saulius Diktanas Oleksandr Korotych Yuliia Sereda Ogtay Gozalov Olga Rubcova Jay Achar |
| author_sort | Saulius Diktanas |
| collection | DOAJ |
| description | The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear–positive, smokers, or with signs of extensive disease evident on initial chest radiography. |
| first_indexed | 2024-12-23T14:20:09Z |
| format | Article |
| id | doaj.art-64ab1b45ae114beb929907b7413dced1 |
| institution | Directory Open Access Journal |
| issn | 1122-0643 2532-5264 |
| language | English |
| last_indexed | 2024-12-23T14:20:09Z |
| publishDate | 2021-01-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Monaldi Archives for Chest Disease |
| spelling | doaj.art-64ab1b45ae114beb929907b7413dced12022-12-21T17:43:48ZengPAGEPress PublicationsMonaldi Archives for Chest Disease1122-06432532-52642021-01-0191110.4081/monaldi.2021.1675Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort studySaulius Diktanas0Oleksandr Korotych1Yuliia Sereda2Ogtay Gozalov3Olga Rubcova4Jay Achar5Republican Klaipeda hospital, Tuberculosis Branch, KlaipedaWorld Health Organization, Regional Office for Europe, CopenhagenWorld Health Organization, Regional Office for Europe, CopenhagenWorld Health Organization, Regional Office for Europe, CopenhagenRepublican Klaipeda hospital, Tuberculosis Branch, KlaipedaDepartment of Global Public Health; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, StockholmThe global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear–positive, smokers, or with signs of extensive disease evident on initial chest radiography.https://monaldi-archives.org/index.php/macd/article/view/1675Predictorscultureconversionmultidrug-resistanttuberculosis |
| spellingShingle | Saulius Diktanas Oleksandr Korotych Yuliia Sereda Ogtay Gozalov Olga Rubcova Jay Achar Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study Monaldi Archives for Chest Disease Predictors culture conversion multidrug-resistant tuberculosis |
| title | Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study |
| title_full | Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study |
| title_fullStr | Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study |
| title_full_unstemmed | Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study |
| title_short | Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study |
| title_sort | factors associated with time to sputum culture conversion of rifampicin resistant tuberculosis patients in klaipeda lithuania in 2016 2019 a cohort study |
| topic | Predictors culture conversion multidrug-resistant tuberculosis |
| url | https://monaldi-archives.org/index.php/macd/article/view/1675 |
| work_keys_str_mv | AT sauliusdiktanas factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy AT oleksandrkorotych factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy AT yuliiasereda factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy AT ogtaygozalov factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy AT olgarubcova factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy AT jayachar factorsassociatedwithtimetosputumcultureconversionofrifampicinresistanttuberculosispatientsinklaipedalithuaniain20162019acohortstudy |