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Published in: BMC Infectious Diseases 1/2018

Open Access 01-12-2018 | Research article

Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China

Authors: Qiao Liu, Peng Lu, Leonardo Martinez, Haitao Yang, Wei Lu, Xiaoyan Ding, Limei Zhu

Published in: BMC Infectious Diseases | Issue 1/2018

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Abstract

Background

Few prospective cohort studies, none in China, have investigated the relationship between treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients and sputum culture conversion. Factors affecting the time of the culture conversion throughout the whole course of the treatment have rarely been investigated.

Methods

This study was performed in four cities in Jiangsu province, China. MDR-TB patients were consecutively enrolled between December 2011 and March 2014. Rates of sputum culture conversion were calculated and Cox proportional-hazards model was performed. Factors contributing to sputum culture conversion were investigated.

Results

In all, 139 MDR-TB patients with treatment outcomes were enrolled. Median time to culture conversion among those who converted was 91.5 days (interquartile range, 34.0–110.8 days). After multivariable analysis, smoking (HR = 0.44; 95% CI: 0.23–0.83), drinking (HR = 0.41; 95% CI: 0.21–0.81), ofloxacin resistance (HR = 0.43; 95% CI: 0.24–0.76) and sputum smear grade > 1 (HR = 0.51; 95% CI: 0.31–0.83) were less likely to have culture conversion.

Conclusions

MDR-TB patients who smoke, drink, have ofloxacin resistance, or a high smear grade are less likely to respond to treatment and should be meticulously followed up.
Literature
2.
go back to reference Teixeira L, Perkins MD, Johnson JL, Keller R, Palaci M, do Valle Dettoni V, Canedo Rocha LM, Debanne S, Talbot E, Dietze R. Infection and disease among household contacts of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2001;5(4):321–8.PubMed Teixeira L, Perkins MD, Johnson JL, Keller R, Palaci M, do Valle Dettoni V, Canedo Rocha LM, Debanne S, Talbot E, Dietze R. Infection and disease among household contacts of patients with multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2001;5(4):321–8.PubMed
3.
go back to reference Nagaraja C, Shashibhushan BL, Asif M, Manjunath PH, Sagar C. Pattern of drug-resistance and treatment outcome in multidrug-resistant pulmonary tuberculosis. Indian J Chest Dis Allied Sci. 2012;54(1):23–6.PubMed Nagaraja C, Shashibhushan BL, Asif M, Manjunath PH, Sagar C. Pattern of drug-resistance and treatment outcome in multidrug-resistant pulmonary tuberculosis. Indian J Chest Dis Allied Sci. 2012;54(1):23–6.PubMed
4.
go back to reference Kurbatova EV, Gammino VM, Bayona J, Becerra MC, Danilovitz M, Falzon D, Gelmanova I, Keshavjee S, Leimane V, Mitnick CD. Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012;16(10):1335–43.CrossRefPubMed Kurbatova EV, Gammino VM, Bayona J, Becerra MC, Danilovitz M, Falzon D, Gelmanova I, Keshavjee S, Leimane V, Mitnick CD. Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012;16(10):1335–43.CrossRefPubMed
5.
go back to reference Kurbatova EV, Cegielski JP, Lienhardt C, Akksilp R, Bayona J, Becerra MC, Caoili J, Contreras C, Dalton T, Danilovits M. Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: a secondary analysis of data from two observational cohort studies. Lancet Respir Med. 2015;3(3):201–9.CrossRefPubMedPubMedCentral Kurbatova EV, Cegielski JP, Lienhardt C, Akksilp R, Bayona J, Becerra MC, Caoili J, Contreras C, Dalton T, Danilovits M. Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: a secondary analysis of data from two observational cohort studies. Lancet Respir Med. 2015;3(3):201–9.CrossRefPubMedPubMedCentral
6.
go back to reference Basit A, Ahmad N, Khan AH, Javaid A, Syed Sulaiman SA, Afridi AK, Adnan AS, Haq I, Shah SS, Ahadi A, et al. Predictors of two months culture conversion in multidrug-resistant tuberculosis: findings from a retrospective cohort study. PLoS One. 2014;9(4):e93206.CrossRefPubMedPubMedCentral Basit A, Ahmad N, Khan AH, Javaid A, Syed Sulaiman SA, Afridi AK, Adnan AS, Haq I, Shah SS, Ahadi A, et al. Predictors of two months culture conversion in multidrug-resistant tuberculosis: findings from a retrospective cohort study. PLoS One. 2014;9(4):e93206.CrossRefPubMedPubMedCentral
7.
go back to reference Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, Jaiswal A, Puri MM, Visalakshi P, Behera D. Seven-year DOTS-plus pilot experience in India: results, constraints and issues. Int J Tuberc Lung Dis. 2009;13(8):976–81.PubMed Singla R, Sarin R, Khalid UK, Mathuria K, Singla N, Jaiswal A, Puri MM, Visalakshi P, Behera D. Seven-year DOTS-plus pilot experience in India: results, constraints and issues. Int J Tuberc Lung Dis. 2009;13(8):976–81.PubMed
8.
go back to reference Rodriguez M, Monedero I, Caminero JA, Encarnacion M, Dominguez Y, Acosta I, Munoz E, Camilo E, Martinez-Selmo S, de los Santos S, et al. Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic. Int J Tuberc Lung Dis. 2013;17(4):520–5.CrossRefPubMed Rodriguez M, Monedero I, Caminero JA, Encarnacion M, Dominguez Y, Acosta I, Munoz E, Camilo E, Martinez-Selmo S, de los Santos S, et al. Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic. Int J Tuberc Lung Dis. 2013;17(4):520–5.CrossRefPubMed
9.
go back to reference Zhao Y, Xu S, Wang L, Chin DP, Wang S, Jiang G, Xia H, Zhou Y, Li Q, Ou X. National survey of drug-resistant tuberculosis in China. N Engl J Med. 2012;366(23):2161–70.CrossRefPubMed Zhao Y, Xu S, Wang L, Chin DP, Wang S, Jiang G, Xia H, Zhou Y, Li Q, Ou X. National survey of drug-resistant tuberculosis in China. N Engl J Med. 2012;366(23):2161–70.CrossRefPubMed
10.
go back to reference Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, Van Soolingen D, Jensen P, Bayona J. Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet. 2010;375(9728):1830–43.CrossRefPubMed Gandhi NR, Nunn P, Dheda K, Schaaf HS, Zignol M, Van Soolingen D, Jensen P, Bayona J. Multidrug-resistant and extensively drug-resistant tuberculosis: a threat to global control of tuberculosis. Lancet. 2010;375(9728):1830–43.CrossRefPubMed
11.
go back to reference Peng L, Qiao L, Martinez L, Yang H, Wei L, Ding X, Zhu L. Time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis: a prospective cohort study from urban China. Eur Respir J. 2017;49(3):1601558.CrossRef Peng L, Qiao L, Martinez L, Yang H, Wei L, Ding X, Zhu L. Time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis: a prospective cohort study from urban China. Eur Respir J. 2017;49(3):1601558.CrossRef
12.
go back to reference Liu Q, Zhu L, Shao Y, Song H, Li G, Zhou Y, Shi J, Zhong C, Chen C, Lu W. Rates and risk factors for drug resistance tuberculosis in northeastern China. BMC Public Health. 2013;13(1):1.CrossRef Liu Q, Zhu L, Shao Y, Song H, Li G, Zhou Y, Shi J, Zhong C, Chen C, Lu W. Rates and risk factors for drug resistance tuberculosis in northeastern China. BMC Public Health. 2013;13(1):1.CrossRef
13.
go back to reference Jaramillo E. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: World Health Organization; 2008. Jaramillo E. Guidelines for the programmatic management of drug-resistant tuberculosis. Geneva: World Health Organization; 2008.
14.
go back to reference Velayutham B, Nair D, Kannan T, Padmapriyadarsini C, Sachdeva KS, Bency J, Klinto JS, Haldar S, Khanna A, Jayasankar S, et al. Factors associated with sputum culture conversion in multidrug-resistant pulmonary tuberculosis. Int J Tuberc Lung Dis. 2016;vol 20:1671–6.CrossRef Velayutham B, Nair D, Kannan T, Padmapriyadarsini C, Sachdeva KS, Bency J, Klinto JS, Haldar S, Khanna A, Jayasankar S, et al. Factors associated with sputum culture conversion in multidrug-resistant pulmonary tuberculosis. Int J Tuberc Lung Dis. 2016;vol 20:1671–6.CrossRef
15.
go back to reference Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V, Zarovska E, Skripconoka V, Wells CD, Leimane V. Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Ann Intern Med. 2006;144(9):650–9.CrossRefPubMed Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V, Zarovska E, Skripconoka V, Wells CD, Leimane V. Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome. Ann Intern Med. 2006;144(9):650–9.CrossRefPubMed
16.
go back to reference Magee MJ, Kempker RR, Kipiani M, Tukvadze N, Howards PP, Narayan KM, Blumberg HM. Diabetes mellitus, smoking status, and rate of sputum culture conversion in patients with multidrug-resistant tuberculosis: a cohort study from the country of Georgia. PLoS One. 2014;9(4):e94890.CrossRefPubMedPubMedCentral Magee MJ, Kempker RR, Kipiani M, Tukvadze N, Howards PP, Narayan KM, Blumberg HM. Diabetes mellitus, smoking status, and rate of sputum culture conversion in patients with multidrug-resistant tuberculosis: a cohort study from the country of Georgia. PLoS One. 2014;9(4):e94890.CrossRefPubMedPubMedCentral
17.
go back to reference Hafkin J, Modongo C, Newcomb C, Lowenthal E, Macgregor RR, Steenhoff AP, Friedman H, Bisson GP. Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana. Int J Tuberc Lung Dis. 2013;17(3):348–53.CrossRefPubMedPubMedCentral Hafkin J, Modongo C, Newcomb C, Lowenthal E, Macgregor RR, Steenhoff AP, Friedman H, Bisson GP. Impact of the human immunodeficiency virus on early multidrug-resistant tuberculosis treatment outcomes in Botswana. Int J Tuberc Lung Dis. 2013;17(3):348–53.CrossRefPubMedPubMedCentral
18.
go back to reference Yuen CM, Kurbatova EV, Tupasi T, Caoili JC, Van Der Walt M, Kvasnovsky C, Yagui M, Bayona J, Contreras C, Leimane V, et al. Association between regimen composition and treatment response in patients with multidrug-resistant tuberculosis: a prospective cohort study. PLoS Med. 2015;12(12):e1001932.CrossRefPubMedPubMedCentral Yuen CM, Kurbatova EV, Tupasi T, Caoili JC, Van Der Walt M, Kvasnovsky C, Yagui M, Bayona J, Contreras C, Leimane V, et al. Association between regimen composition and treatment response in patients with multidrug-resistant tuberculosis: a prospective cohort study. PLoS Med. 2015;12(12):e1001932.CrossRefPubMedPubMedCentral
19.
go back to reference Maciel EL, Brioschi AP, Peres RL, Guidoni LM, Ribeiro FK, Hadad DJ, Vinhas SA, Zandonade E, Palaci M, Dietze R, et al. Smoking and 2-month culture conversion during anti-tuberculosis treatment. Int J Tuberc Lung Dis. 2013;17(2):225–8.CrossRefPubMedPubMedCentral Maciel EL, Brioschi AP, Peres RL, Guidoni LM, Ribeiro FK, Hadad DJ, Vinhas SA, Zandonade E, Palaci M, Dietze R, et al. Smoking and 2-month culture conversion during anti-tuberculosis treatment. Int J Tuberc Lung Dis. 2013;17(2):225–8.CrossRefPubMedPubMedCentral
20.
go back to reference Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, Tai LB, Leung EC, Au RK, Huang SS, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J. 2015;45(3):738–45.CrossRefPubMed Leung CC, Yew WW, Chan CK, Chang KC, Law WS, Lee SN, Tai LB, Leung EC, Au RK, Huang SS, et al. Smoking adversely affects treatment response, outcome and relapse in tuberculosis. Eur Respir J. 2015;45(3):738–45.CrossRefPubMed
21.
go back to reference Nijenbandring de Boer R, Souza Filho JB O e, Cobelens F, Ramalho Dde P, Campino Miranda PF, Logo K, Oliveira H, Mesquita E, Oliveira MM, Kritski A. Delayed culture conversion due to cigarette smoking in active pulmonary tuberculosis patients. Tuberculosis (Edinb). 2014;94(1):87–91.CrossRef Nijenbandring de Boer R, Souza Filho JB O e, Cobelens F, Ramalho Dde P, Campino Miranda PF, Logo K, Oliveira H, Mesquita E, Oliveira MM, Kritski A. Delayed culture conversion due to cigarette smoking in active pulmonary tuberculosis patients. Tuberculosis (Edinb). 2014;94(1):87–91.CrossRef
22.
go back to reference Qazi F, Khan U, Khowaja S, Javaid M, Ahmed A, Salahuddin N, Hussain H, Becerra MC, Golub JE, Khan AJ. Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan. Int J Tuberc Lung Dis. 2011;15(11):1556.CrossRefPubMed Qazi F, Khan U, Khowaja S, Javaid M, Ahmed A, Salahuddin N, Hussain H, Becerra MC, Golub JE, Khan AJ. Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan. Int J Tuberc Lung Dis. 2011;15(11):1556.CrossRefPubMed
23.
go back to reference Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcantara Viru FA, Appleton SC, Bayona JN, et al. Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med. 2008;359(6):563–74.CrossRefPubMedPubMedCentral Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcantara Viru FA, Appleton SC, Bayona JN, et al. Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med. 2008;359(6):563–74.CrossRefPubMedPubMedCentral
24.
go back to reference Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect Dis. 2010;10(9):621–9.CrossRefPubMed Caminero JA, Sotgiu G, Zumla A, Migliori GB. Best drug treatment for multidrug-resistant and extensively drug-resistant tuberculosis. Lancet Infect Dis. 2010;10(9):621–9.CrossRefPubMed
25.
go back to reference Chan ED, Laurel V, Strand MJ, Chan JF, Huynh M-LN, Goble M, Iseman MD. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2004;169(10):1103–9.CrossRefPubMed Chan ED, Laurel V, Strand MJ, Chan JF, Huynh M-LN, Goble M, Iseman MD. Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am J Respir Crit Care Med. 2004;169(10):1103–9.CrossRefPubMed
26.
go back to reference Jabeen K, Shakoor S, Chishti S, Ayaz A, Hasan R. Fluoroquinolone-resistant mycobacterium tuberculosis, Pakistan, 2005-2009. Emerg Infect Dis. 2011;17(3):564–6.CrossRefPubMed Jabeen K, Shakoor S, Chishti S, Ayaz A, Hasan R. Fluoroquinolone-resistant mycobacterium tuberculosis, Pakistan, 2005-2009. Emerg Infect Dis. 2011;17(3):564–6.CrossRefPubMed
27.
go back to reference Wells WA, Ge CF, Patel N, Oh T, Gardiner E, Kimerling ME. Size and usage patterns of private TB drug markets in the high burden countries. PLoS One. 2011;6(5):e18964.CrossRefPubMedPubMedCentral Wells WA, Ge CF, Patel N, Oh T, Gardiner E, Kimerling ME. Size and usage patterns of private TB drug markets in the high burden countries. PLoS One. 2011;6(5):e18964.CrossRefPubMedPubMedCentral
28.
go back to reference Kanda R, Nagao T, Tho NV, Ogawa E, Murakami Y, Osawa M, Saika Y, Doi K, Nakano Y. Factors affecting time to sputum culture conversion in adults with pulmonary tuberculosis: a historical cohort study without censored cases. PLoS One. 2015;10(11):e0142607.CrossRefPubMedPubMedCentral Kanda R, Nagao T, Tho NV, Ogawa E, Murakami Y, Osawa M, Saika Y, Doi K, Nakano Y. Factors affecting time to sputum culture conversion in adults with pulmonary tuberculosis: a historical cohort study without censored cases. PLoS One. 2015;10(11):e0142607.CrossRefPubMedPubMedCentral
29.
go back to reference Caetano Mota P, Carvalho A, Valente I, Braga R, Duarte R. Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis. Rev Port Pneumol. 2012;18(2):72–9.CrossRefPubMed Caetano Mota P, Carvalho A, Valente I, Braga R, Duarte R. Predictors of delayed sputum smear and culture conversion among a Portuguese population with pulmonary tuberculosis. Rev Port Pneumol. 2012;18(2):72–9.CrossRefPubMed
Metadata
Title
Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China
Authors
Qiao Liu
Peng Lu
Leonardo Martinez
Haitao Yang
Wei Lu
Xiaoyan Ding
Limei Zhu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2018
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-018-3021-0

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