Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis
| Autor: | Irina Gelmanova, Allison Taylor, Ekaterina V. Kurbatova, J P Cegielski, Vija Riekstina, Matteo Zignol, Manfred Danilovitz, M. I. D. Quelapio, Vaira Leimane, Salmaan Keshavjee, Carole D. Mitnick, Mercedes C. Becerra, Victoria M. Gammino, Dennis Falzon, Piret Viiklepp, Jaime Bayona |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Tuberculosis Adolescent Antitubercular Agents Microbial Sensitivity Tests Sputum culture Young Adult Predictive Value of Tests Interquartile range Internal medicine Tuberculosis Multidrug-Resistant medicine Culture conversion Humans Tuberculosis Pulmonary Aged Retrospective Studies Aged 80 and over medicine.diagnostic_test Receiver operating characteristic business.industry Hazard ratio Sputum Mycobacterium tuberculosis Middle Aged Pyrazinamide medicine.disease Infectious Diseases ROC Curve Predictive value of tests Female business medicine.drug |
| Zdroj: | The International Journal of Tuberculosis and Lung Disease. 16:1335-1343 |
| ISSN: | 1815-7920 1027-3719 |
| Popis: | Objective To identify predictors of initial sputum culture conversion, estimate the usefulness of persistent positive cultures at different time points in predicting treatment failure, and evaluate different definitions of culture conversion for predicting failure among patients with multidrug-resistant tuberculosis (MDR-TB) in five countries, 2000-2004. Methods Predictors of time to conversion were identified using multivariate Cox proportional hazards regression modeling. Receiver operating characteristic curves were plotted to visualize the effect of using different definitions of 'culture conversion' on the balance between sensitivity and specificity. Results Overall, 1209/1416 (85%) of patients with baseline positive cultures converted in a median of 3.0 months (interquartile range 2.0-5.0). Independent predictors of less likely conversion included baseline positive smear (hazard ratio [HR] 0.60, 95%CI 0.53-0.68), resistance to pyrazinamide (HR 0.82, 95%CI 0.70-0.96), fluoroquinolones (FQs; HR 0.65, 95%CI 0.51-0.83) or thioamide (HR 0.83, 95%CI 0.71-0.96), previous use of FQs (HR 0.71, 95%CI 0.60-0.83), poor outcome of previous anti-tuberculosis treatment (HR 0.69, 95%CI 0.54-0.88) and alcoholism (HR 0.74, 95%CI 0.63-0.87). The maximum combined sensitivity (84%) and specificity (94%) in predicting treatment failure was based on lack of culture conversion at month 9 of treatment, assuming conversion is defined as five consecutive negative cultures. Conclusion Patients with identified risk factors were less likely to achieve sputum culture conversion during MDR-TB treatment. |
| Databáze: | OpenAIRE |
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