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

Artificial intelligence-based radiographic extent analysis to predict tuberculosis treatment outcomes: a multicenter cohort study

Predicting outcomes in pulmonary tuberculosis is challenging despite effective treatments. This study aimed to identify factors influencing treatment success and culture conversion, focusing on artificial intelligence (AI)-based chest X-ray analysis and Xpert MTB/RIF assay cycle threshold (Ct) values. In this retrospective study across six South Korean referral centers (January 1 to December 31, 2019), we included adults with rifampicin-susceptible pulmonary tuberculosis confirmed by Xpert assay from sputum samples. We analyzed patient characteristics, AI-based tuberculosis extent scores from chest X-rays, and Xpert Ct values. Of 230 patients, 206 (89.6%) achieved treatment success. The median age was 61 years, predominantly male (76.1%). AI-based radiographic tuberculosis extent scores (median 7.5) significantly correlated with treatment success (odds ratio [OR] 0.938, 95% confidence interval [CI] 0.895-0.983) and culture conversion at 8 weeks (liquid medium: OR 0.911, 95% CI 0.853-0.973; solid medium: OR 0.910, 95% CI 0.850-0.973). Sputum smear positivity was 49.6%, with a median Ct of 26.2. However, Ct values did not significantly correlate with major treatment outcomes. AI-based radiographic scoring at diagnosis is a significant predictor of treatment success and culture conversion in pulmonary tuberculosis, underscoring its potential in personalized patient management.

Evaluation of time to sputum smear conversion and its association with treatment outcomes among drug-resistant tuberculosis patients: a retrospective record-reviewing study

Background: This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases. Methods: The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants. Results: Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5 years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97 kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion (p < 0.001, aOR = 5.817, and 95% CI = 3.703-9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855-0.907, and p < 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion (p < 0.001, aOR = 7.446, and 95% CI = 4.869-11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835-0.889, and p < 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877-0.927, and p < 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes. Conclusions: Within 2 months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.

Study of Culture Conversion in Drug-Resistant Pulmonary Tuberculosis on All-Oral Longer Regimen at IGIMS, Patna

Background

Multidrug-resistant tuberculosis (MDR-TB) refers to tuberculosis that resists at least two primary drugs, namely isoniazid and rifampicin. To assess the management of MDR-TB, sputum culture conversion is performed. This study aimed to determine the culture conversion status of MDR-TB patients undergoing an all-oral longer regimen.

Methods

This research constitutes an observational and prospective study conducted within a hospital setting. The study was done at the Department of Microbiology, IGIMS, Patna, from October 2020 to March 2022. Culture conversion in multidrug resistance pulmonary tuberculosis on all-oral longer regimens took one spot and one morning sample of sputum as per standard protocol after completing two months of all-oral longer regimens and culturing it in liquid broth using Mycobacterium Growth Indicator Tube (MGIT) 960 System at two, four then six months till we got a negative result.

Results

Maximum number of the cases, 77 (74.8%), belonged to 19-35 years of age group. Males were 68 (66.1%) and females were 35 (33.9%), respectively, with male to female ratio of 1.9:1. After 2 months of oral longer regimen treatment, out of 103 cases, we found 98 (95.1%) patients had sputum for culture positive and only five (4.2%) patients had sputum for culture negative. After 6 months of oral longer regimen treatment, out of 101 cases, we found 16 (15.8%) patients had sputum for culture positive and 85 (85.2%) patients had sputum for culture negative.

Conclusion

In patients with multidrug-resistant pulmonary tuberculosis (MDR-TB) who received an all-oral longer regimen, the introduction of bedaquiline led to positive outcomes as evidenced by a greater number of negative sputum cultures, a decrease in culture reversions, and a reduced risk of developing a more resistant form of MDR-TB.

TB therapeutic drug monitoring - analysis of opportunities in Romania and Ukraine

INTRODUCTION: Therapeutic drug monitoring (TDM) could improve TB treatment outcomes by avoiding drug toxicity or underdosing. In this study, we describe the patient burden in three TB centres in Romania and Ukraine with a TDM indication, as per the current guidelines, in order to estimate the feasibility of implementing TDM.METHODS: A retrospective multi-centre study was conducted at the Iasi Lung Hospital (Iasi, Romania), Bucharest Marius Nasta Institute (Bucharest, Romania) and Chernivtsi TB Centre (Chernivtsi, Ukraine) in adult hospitalised TB patients.RESULTS: A total of 927 participants were admitted, of whom 37.8% had at least one indication for TDM, the most frequent being slow response to TB treatment (202/345, 58.6%); 55.5% had at least one cavity present on chest X-ray. Patients with a TDM indication stayed in the hospital for a median of 67 days and took on average 2 months more to reach a successful TB outcome.CONCLUSION: TDM could be a valuable tool to improve management of selected TB patients. The decision on whether to perform TDM is often delayed by 2 months due to waiting for culture results after treatment initiation. A randomised control trial should be performed in order to define TDM's precise role in TB therapy.

Time to Sputum Culture Conversion and Its Predictors Among Multidrug Resistant Tuberculosis Patients in Tigray, Northern Ethiopia: Retrospective Cohort Study

Background

Sputum culture conversion status is a cardinal index of treatment response and patient outcome for MDR TB patients on longer anti-TB drugs. But, there is limited information on time to sputum culture conversion of MDR TB patients on a longer anti-TB treatment regimen. Therefore, this study aimed to evaluate time to sputum culture conversion and its predictors among MDR TB patients in Tigray, Northern Ethiopia.

Methods

A retrospective cohort study was conducted from January 2017 through September 2020 among MDR TB patients in Tigray, Northern Ethiopia. Demographic and clinical characteristics including bacteriological data were extracted from the TB registration book and electronic database in Tigray Health Research Institute. Statistical analysis was performed using SPSS version 25. The time to initial sputum culture conversion was analyzed using the Kaplan-Meier method. Bivariate and multivariate Cox proportional hazards regression analyses were used to identify predictors for culture conversions. P <0.05 was considered statistically significant.

Results

A total of 294 eligible study participants with a median age of 30 years (IQR: 22.75-40) were included. The participants were followed for a total of 1066.7 person months. Sputum culture conversion was achieved in 269 (91%) of the study participants. The median time of sputum culture conversion was 64 days (IQR: 49-86). In our multivariate model, HIV-positive (aHR=1.529, 95% CI: 1.096-2.132, P=0.012), patients new to anti-TB treatment (aHR=2.093, 95% CI: 1.100-3.982, P=0.024) and baseline AFB smear grading of +1 (aHR=1.982, 95% CI: 1.428-2.750, P=0.001) significantly affected time to initial sputum culture conversion.

Conclusion

The median time of culture conversion was 64 days. Moreover, the majority of the study participants achieved culture conversion within the first six months of treatment commencement, which supports predefined standard treatment durations.

Smear grading at initial treatment association with treatment outcomes among new smear positive pulmonary tuberculosis patients: A retrospective study

Introduction

Tuberculosis (TB) is one of the most challenging diseases in diagnosis, treatment and control. We aimed to assess the association of the initial grading of Mycobacterium Sputum Smear (MSS) on the outcomes of TB treatment.

Materials and methods

In a retrospective study, data of 418 positive pulmonary smear patients were retrieved from the TB registration system in Iran during 2014 to 2021. Patients' data included demographic, laboratory and clinical information and were recorded in our checklist. The grading of Mycobacterium Sputum Smear (MSS) at the initial treatment was assessed based on World Health Organization (WHO) guidelines. Chi-square test was used to assess the relationship between tuberculosis treatment outcomes and Mycobacterium grade at initial treatment in SPSS.

Results

The mean age of cases was 51.19 ± 22.29 years old and varied between 14 and 95 years. Laboratory results showed that the rate of 1-9, 1+,2+ and 3+ Mycobacterium tuberculosis was 17.7%, 44.3%, 19.4% and 18.7%, respectively. The rate of cure, death and treatment failure in patients was 87.1%, 6.9%, and 1.2%, respectively. The highest mortality rate (11.5%) occurred in patients with 3+ and the lower rate of cure was 79.5% in this group. Moreover, by increasing the Mycobacterium grade the rate of transferred out and lost to follow up from treatment increased (p = 0.024).

Conclusion

High smear grading of sputum is inversely associated with lower curing and on-time treatment. Moreover, by increasing the Mycobacterium grade at initial treatment, treatment failure and lost to follow up increased Therefore, improvement the health system and patient-diagnosis and screening programs is necessary to on-time diagnosis and facilitate the treatment process.

Impact of N-Acetyl Cysteine (NAC) on Tuberculosis (TB) Patients-A Systematic Review

Sustained TB infection overproduces reactive oxygen species (ROS) as a host defense mechanism. Research shows ROS is destructive to lung tissue. Glutathione (GSH) neutralizes ROS, although it is consumed. NAC is a precursor of GSH synthesis, and administering an appropriate dose of NAC to patients with respiratory conditions may enhance lung recovery and replenish GSH. The present review searched for articles reporting on the effects of NAC in TB treatment from 1960 to 31 May 2022. The PICO search strategy was used in Google Scholar, PubMed, SciFinder, and Wiley online library databases. The COVIDENCE tool was used to delete inappropriate content. We eventually discovered five clinical trials, one case report, seven reviews, in vitro research, and four experimental animal studies from the twenty-four accepted articles. The use of NAC resulted in increased GSH levels, decreased treatment time, and was safe with minimal adverse events. However, the evidence is currently insufficient to estimate the overall effects of NAC, thus the study warrants more NAC clinical trials to demonstrate its effects in TB treatment.

Impact of alcohol drinking and tobacco smoking on the drug-resistance of newly diagnosed tuberculosis: a retrospective cohort study in Shandong, China, during 2004-2020

OBJECTIVES

To investigate the independent and collective impact of alcohol drinking and tobacco smoking on the drug-resistance of newly diagnosed tuberculosis (TB).

DESIGN

This was a retrospective cohort study.

SETTING

Shandong, China.

PARTICIPANTS

Patients with newly diagnosed TB from 1 January 2004 to 31 December 2020 were collected. Exclusive criteria: retreated cases; extrapulmonary tuberculosis; without information on drug susceptibility testing results, smoking or drinking habits; bacteriological identification as non-tuberculous mycobacteria.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patients were classified into four groups including smokers only (G₁), drinker only (G₂), smoker +drinker (G₃), non-smoker +non-drinker group (G₀). We described the drug-resistant profiles, clinical factors and calculated the ORs of different drug-resistance among G₁, G₂, G₃, compared with G₀ through univariate and multivariate logistics regression models.

RESULTS

Of the 7996 TB cases enrolled, the proportions of G₁, G₂, G₃ and G₀ were 8.25%, 3.89%, 16.46% and 71.40%, respectively. The rates of drug-resistant (DR)-TB, mono-resistant TB, multidrug resistant (MDR)-TB, polydrug resistant TB in G_1, G₂, G₃ and G₀ were 19.24%/16.4%/17.33%/19.08%, 11.52%/8.68%/10.94%/11.63%, 3.03%/2.57%/2.96%/3.66% and 4.70%/4.82%/3.34%/ 4.08%, respectively. G₃ had a higher risk of MDR1: isoniazid +rifampin (adjusted OR (aOR)=1.91, 95% CI: 1.036 to 3.532), but had a lower risk of DR-TB (aOR=0.84, 95% CI: 0.71 to 0.99), rifampin-related resistance (aOR=0.68, 95% CI: 0.49 to 0.93), streptomycin-related resistance (aOR=0.82, 95% CI: 0.68 to 0.99), ethambutol-related resistance (aOR=0.57, 95% CI: 0.34 to 0.95), MDR3: isoniazid +rifampin+streptomycin (aOR=0.41, 95% CI: 0.19 to 0.85), any isoniazid +streptomycin resistance (aOR=0.85, 95% CI: 0.71 to 1.00). However, there were no significant differences between G₁ and G₀, G₂ and G₀ in all drug-resistant subtypes. Those patients with cavity had a higher risk of DR-TB among G₃ (OR=1.35, 95% CI: 1.01 to 1.81).

CONCLUSION

Although we did not found an independent impact of alcohol drinking or tobacco smoking on TB drug-resistance, respectively, these two habits had a combined effect on TB drug-resistance.

Factors associated with treatment outcome of MDR/RR-TB patients treated with shorter injectable based regimen in West Java Indonesia

Background and aims

Multi drug or rifampicin resistant tuberculosis (MDR/RR-TB) is a major burden to TB prevention and eradication globally. Since 2016, WHO guidelines have included options for treating MDR/RR-TB with a standard regimen of 9 to 11 months duration (the ’shorter regimen’) rather than an individual regimen of at least 20 months. This regimen has been introduced in Indonesia since September 2017. Therefore, we aimed to determine the success rate and factors associated with the treatment outcome of shorter injectable based regimen in West Java province, Indonesia.

Methods

This was a retrospective cohort study of MDR/RR-TB patients aged over 18 years old who received the shorter injectable based regimen between September 2017 and December 2020. We defined successful outcomes as the combined proportion of patients who were cured or had complete treatment. While, unsuccessful outcomes were defined as the combined proportion of patients who died from any causes, failure, and loss to follow-up (LTFU).

Results

A total of 315 patients were included in this study. The success rate was 64.5%. Multivariate analysis showed male gender (aRR = 1.18, 95% CI 1.04 to 1.34) increased the chance of successful outcome, while malnutrition (aRR = 0.78, 95% CI 0.68 to 0.89), history of previous TB treatment (aRR = 0.80%CI 0.68 to 0.94), and time of culture conversion >2 months (aRR = 0.72 (95% CI 0.59 to 0.87) decreased the chance of successful outcome.

Conclusion

History of previous TB treatment, time of culture conversion >2 months, and malnutrition were independent factors that decrease the chance for success rate, while male gender increase the likelihood for success rate of patients treated by the shorter injectable based regimen.

A Retrospective Comparative Study on Median Time to Sputum Culture Conversion in Multi-Drug Resistant Pulmonary Tuberculosis Patients in Pastoral and Non-Pastoral Settings in Southeast Oromia, Ethiopia

Purpose

Sputum culture conversion to negative is an indicator of good interim treatment outcome. Pastoralist community has lesser access to healthcare services. This study aimed to compare the time to culture conversion (TTSCC) between the pastoral and non-pastoral settings and identify its determinants among drug-resistant pulmonary TB patients.

Patients and Methods

Four hundred forty-seven drug-resistant pulmonary TB patients were included from selected hospitals of southeastern Oromia, Ethiopia. Kaplan–Meier model using the Log rank test was fit to compute and compare median TTSCC between study participants from the pastoral and non-pastoral settings. The Cox proportional hazard model was fit to identify factors associated with the TTSCC. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was used to report the strength of association. Statistical significance was declared at p < 0.05.

Results

The study participants’ median age (interquartile range) was 29 (24–36) years. The overall median TTSCC among the current study participants was 67 (95% CI, 64–70) days. It was significantly different for patients from the pastoral and non-pastoral settings (p-value <0.001). The median TTSCC for patients from pastoral and non-pastoral settings was 101 (95% CI, 81–121) and 63 (95% CI, 61–64) days. To mention few determinants, patients from the pastoral setting had a 69% lower chance [HR = 0.31 (95% CI 0.24–0.41)] of shorter TTSCC than patients from the non-pastoral setting. Furthermore, patients with baseline body mass index greater than 18.5Kg/M² had a 35% higher chance of shorter TTSCC [HR = 1.35 (95% CI 1.07–1.71)] compared to their counterparts.

Conclusion

The median TTSCC among the study participants from pastoral was longer than those from non-pastoral setting. The pastoral setting, under-nutrition, previous exposure to anti-TB drugs and drug regimen categories were among the notable determinants of the TTSCC among our study participants. Hence, due attention should be given to patients with these determinants during the treatment.

Prediction of Treatment Outcome with Inflammatory Biomarkers after 2 Months of Therapy in Pulmonary Tuberculosis Patients: Preliminary Results

Pro-inflammatory mediators play an important role in the pathogenesis of pulmonary tuberculosis. Consecutively, 26 pulmonary tuberculosis patients were enrolled in our study based on the exclusion criteria. We have used Spearman’s correlation analysis, hierarchical clustering and regression modelling to evaluate the association of 11 biomarkers with culture status after antituberculosis treatment. The results of our study demonstrated that six inflammatory biomarkers of 11, C-reactive protein (CRP), white blood cells (WBC), neutrophils, interferon gamma inducible protein 10, C-reactive protein (CRP) to albumin ratio (CAR) and neutrophil to albumin ratio (NAR), were significantly associated with culture negativity. The predictive ability of a composite model of seven biomarkers was superior to that of any single biomarker based on area under the receiver operating characteristic curve (AUC) analysis, indicating an excellent prediction efficacy (AUC:0.892; 95% CI:0.732-1.0). We also found that the highest significant trends and lower levels of CRP and IP-10 were observed in the two-month treated tuberculosis (TB) patients. We believe that our study may be valuable in providing preliminary results for an additional strategy in monitoring and management of the clinical outcome of pulmonary tuberculosis. Using a panel of predictors added a superior value in predicting culture status after anti-TB therapy.

Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study

BACKGROUND

Sputum smear conversion is a key indicator of treatment response and reduced infectivity among bacteriologically confirmed pulmonary tuberculosis (PTB) patients. This study aimed at estimating sputum smear conversion and identifying factors hindering sputum smear conversion among bacteriologically confirmed PTB cases in East Gojjam Zone, Northwest Ethiopia.

METHODS

A total of 282 bacteriologically confirmed PTB patients were followed for 22 weeks through weekly sputum smear examination. Due to the absence of sputum culture and rapid diagnostic services, sputum smear conversion evaluation was conducted microscopically using acid-fast-bacilli staining technique of sediments from a 5% sodium hypochlorite concentration technique. Data on socio-demographic, clinical profile and personal behavior variables were collected using a pretested interviewer-administered questionnaire. Various descriptive statistics including mean, median with interquartile range (IQR), and proportions were computed to describe study objectives. Factors of sputum smear conversion were identified by multivariable logistic regression analysis and statistical significance was determined at a p value < 0.05.

RESULTS

Over half, 166 (59%) of bacteriologically confirmed PTB patients were males and 147 (52%) were rural dwellers. The mean age of respondents was 35 ± 5 SD years. About 88 (31.2%) of bacteriologically confirmed PTB patients had comorbidities, 102 (36.2%) faced stigma, and 54 (19%) history of cigarette smoking. The median sputum smear conversions during the intensive phase and 5th  months of treatment follow up were 35 dyas (IQR: 21-56 days) and 53 days (IQR: 28-82 days), respectuvely. The majority, 85% (95% CI 76-93%) and 95% (95% CI 85-99%) of bacteriologically confirmed PTB patients underwent sputum smear conversion at the end of 2nd and 5th months of treatment, respectively. Poor knowledge on TB, being HIV positive, higher smear grading, having diabetes mellitus, undernutrition, cigarette smoking, facing societal stigma, and TB service delays were positively associated with the length of sputum smear conversion (p value < 0.05).

CONCLUSION

Based on this study, the median sputum smear conversion time was higher compared to TB program expectations and findings from former studies. The study also identified important factors associated with sputum smear conversion time. Improving health literacy of the community by revising the existing community awareness strategies is essential to enhance treatment adherence and lower infectiousness after treatment initiation.

Sputum smear grading and associated factors among bacteriologically confirmed pulmonary drug-resistant tuberculosis patients in Ethiopia

Background

The sputum smear bacilliary load is a fundamental indicator of the level of infectiousness in DR-TB patients. However, evidence on DR-TB sputum smear grading and its factors in the study setting is limited. This study was aimed to determine the level of sputum smear grading and associated factors among DR-TB patients in Ethiopia.

Methods

This was an institution based cross-sectional study on 520 bacteriological confirmed pulmonary DR-TB patients from September 2010 to December 2017 in the northwest Ethiopia. Epidata 4.2.00 and SPSS 20 were used for data entry and management, respectively. Ordinary logistic regression was fitted. A cut of p-value less than 0.05 in the multivariable ordinary logistic regression was considered to declare statistically significant variables.

Results

Of all 520 bacteriological confirmed pulmonary DR-TB patients; 34.42% had 3⁺, 15.77% had 2⁺, 18.27% had 1⁺, 15.19% had scanty, and 16.35% had negative sputum smear grading results. The odds of having higher sputum smear grades were significantly associated with the patient’s educational status of secondary (Adjusted Odds Ratio (AOR) = 0.43, 95% Confidence Interval (CI): 0.21, 0.89), body mass index of 16 to 18.49 kg/m² (AOR = 1.81, 95%CI: 1.16, 2.84), and TB treatment history of two and more times (AOR = 1.78, 95%CI: 1.24, 2.55).

Conclusions

More than a third of the bacteriological confirmed pulmonary DR-TB patients in the study setting was highly infectious with the highest bacillary load. The odds of having a high bacillary load were significantly associated with the patient’s TB treatment history, nutritional, and educational status.

Factors affecting outcome of longer regimen multidrug-resistant tuberculosis treatment in West Java Indonesia: A retrospective cohort study

Background

Multidrug-resistant tuberculosis had high treatment failure and mortality. Success rate of treatment currently 56% at global level, 48% in Indonesia and 36% in West Java province, the most populated province and surround Jakarta, the capitol of Indonesia.

Objective

This study aimed to evaluate factors affecting success of multidrug-resistant tuberculosis treatment in patients using longer treatment regimen in West Java Indonesia.

Methods

This was a retrospective cohort study of multidrug-resistant tuberculosis patients treated with longer regimen at Hasan Sadikin General Hospital from January 2015 to December 2017. Potential risk factors associated with the treatment outcome were analyzed using multiple logistic regression.

Results

A total of 492 patients were enrolled during the study period. Fifty percents multidrug-resistant tuberculosis patients had successful treatment outcome. Age ≤45 years, male, normal body mass index, no previous tuberculosis treatment, culture conversion ≤2 months, acid fast bacilli sputum smear ≤+1 were independent factors associated with increased treatment success. Sputum culture conversion ≤2 months was the major factor affecting successful outcome (RR 2.79; 95% CI: 1.61–4.84; p-value<0.001). Human Immunodeficiency Virus infection, chronic kidney disease, and cavitary lesion were independent risk factors for unfavourable outcome.

Conclusion

Age, gender, body mass index, tuberculosis treatment history, time of sputum conversion, acid fast bacilli sputum smear, HIV infection, chronic kidney disease, and cavitary lesion can be used as predictors for longer multidrug-resistant tuberculosis treatment regimen outcome.

Safety and effectiveness of an all-oral, bedaquiline-based, shorter treatment regimen for rifampicin-resistant tuberculosis in high HIV burden rural South Africa: a retrospective cohort analysis

Background

At the end of 2018, South Africa updated its all-oral regimen, to include bedaquiline (BDQ) and 2 months of linezolid (LZD) for all patients initiating the shorter 9–12 months regimen for rifampicin-resistant tuberculosis (RR-TB). We assessed a group of patients in rural KwaZulu-Natal for safety and effectiveness of this treatment regimen under programmatic conditions.

Methods

We conducted a retrospective cohort analysis on RR-TB patients treated with a standardized all-oral short regimen between 1 July 2018 and 30 April 2019 in 3 facilities in King Cetshwayo District. An electronic register (EDR web) and facility-based clinical charts were used to collect variables, which were entered into an Epi-Info database.

Results

Our cohort included 117 patients; 68.4% (95% confidence interval [CI]: 59.3–76.3) tested positive for human immunodeficiency virus (HIV). The median time to culture conversion was 56 days (95% CI: 50–57). Treatment success was achieved in 75.2% (95% CI: 66.5–82.3) of patients. Mortality within the cohort was 12.8% (95% CI: 7.8–20.3). Anemia was the most frequent severe adverse event (AE). The median time to develop severe anemia was 7.1 weeks (interquartile range [IQR] 4.0–12.9) after treatment initiation. LZD was interrupted in 25.2% (95% CI: 17.8–34.5) of participants.

Conclusions

An all-oral shorter regimen, including BDQ and LZD as core drugs for the treatment of RR-TB, shows good outcomes, in a high HIV burden rural setting. AEs are common, especially for LZD, but could be managed in the program setting. Support is needed when introducing new regimens to train staff in the monitoring, management, and reporting of AEs.

Impact of different tuberculosis history at the onset of future multidrug-resistant tuberculosis: A large, retrospective, population-based cohort study

OBJECTIVES

The impact of tuberculosis (TB) history on the risk of multidrug-resistant tuberculosis (MDR-TB) is not yet fully understood. We aimed to identify the impact of different TB history at the onset of future MDR-TB.

METHODS

A large, retrospective, population-based cohort study was performed between 2005 and 2019. A multivariable Cox model was used to evaluate independent risk factors for MDR-TB for individuals with different previous TB history (PTBH), such as newly diagnosed TB history (NDTH) and re-treated TB history (RTH).

RESULTS

Overall, 12 172 individuals with PTBH were included in this study. The main impacts of different PTBH at the onset of future MDR-TB were as follows: (a) low family income, high-risk occupation, TB patients with severe infection, extended or shortened treatment course, 2H3R3Z3E3/4H3R3 and frequency of sputum culture were significantly linked to incident MDR-TB only in individuals with NDTH (P < 0.05); (b) passive mode of TB case finding, individualised treatment regimens, 3HRZES/6HRE, duration of pulmonary cavities, excellent frequency of chest X-ray examination and duration of negative sputum smear were significantly associated with incident MDR-TB only in individuals with RTH (P < 0.05); (c) age <60 years, history of direct contact, human immunodeficiency virus (HIV) infection, unsuccessful treatment and duration of positive sputum culture were related to incident MDR-TB in both categories of PTBH individuals (P < 0.05).

CONCLUSION

Early and differential surveillances, assessments and interventions for reducing the risk of MDR-TB among individuals with different PTBH play a key role.

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

The objective is to investigate the time to initial sputum culture conversion (SCC) and its predictors among multidrug-resistant tuberculosis (MDR-TB) patients in Hangzhou, China.A retrospective cohort study was conducted among patients who initiated MDR-TB treatment from 2011 to 2015 in Hangzhou, China. Successful achievement of initial SCC was defined as 2 consecutive negative cultures taken at least 30 days apart after initiation of treatment of MDR-TB. Successful treatment outcomes included being cured and completing treatment, while poor treatment outcomes included treatment failure, loss to follow-up, and death. Time to initial SCC was analyzed using the Kaplan-Meier method, and Cox proportional hazards regression was used to identify predictors of SCC.Among 384 patients enrolled with MDR-TB, 359 (93.5%) successfully achieved initial SCC after a median of 85 days (interquartile range, 40-112 days). A higher rate of SCC was observed in participants with successful treatment outcomes than those with poor treatment outcomes (P<.01). Multivariate analysis showed that age 25 to 64 years (compared with age<25; adjusted odds ratio [AOR], 0.7; 95% confidence interval [CI], 0.5-0.9; P < .01), age ≥65 years (compared with age < 25; AOR, 0.5; 95% CI, 0.3-0.8; P < .01), and household registration in Hangzhou (compared with non-Hangzhou registration; AOR, 1.3; 95% CI, 1.0-1.5; P < .05) were found to be associated with SCC.Although high SCC and treatment success rates were observed among MDR-TB patients in Hangzhou, the prolonged duration to initial SCC underscores the importance of emphasizing measures for infection control. A new policy of shifting outpatient treatment to inpatient treatment in China may reduce the risk of transmission from patients in the time window prior to SCC.

Drug-Resistant Tuberculosis: Correlation between Positivity of Acid-Fast Bacilli Sputum and Time to Conversion on Patients with Short-Term Treatment Regimen

Drug-resistant tuberculosis (DR-TB) is a worldwide global burden and related to poor treatment outcomes. Monitoring the progress of DR-TB treatment can be carried out microscopic with Acid-Fast Bacilli (AFB) sputum smear and assessed from the beginning or the first time the patient is diagnosed and monthly to determine the sequential conversion of AFB baseline to the next month twice until it becomes negative. The prolonged conversion has been associated with infectiousness and treatment outcomes. This study was aimed to determine the correlation between positivity of AFB sputum and time to conversion in DR-TB patients with short-term treatment (STR) regimen. An analytic retrospective at hospital collected from medical records of DR-TB patients, from September 2017 to July 2018. Spearman technique was used to analyze the data with p < 0.05. From the total of 151 DR-TB patients on STR regimen, 51 patients were enrolled consisting of 30 (58.8%) males and 21 (41.2%) females with ages average were 51 ± 12.9 years old. Overall, 39 (76.5%) patients had time of AFB conversion in the first month, 9 (17.6%) patients in the second months, 2 (3.9%) patients in the third months, and 1 (2%) patient in the fourth months. Among those patients, 26 (51%) patients had completed the treatment outcomes, 22 (43.1%) were loss to follow-up, 1 (2%) patient had the treatment failure, and 2 (3.9%) were died. There was no significant correlation between AFB sputum baseline (Scanty, 1+, 2+, 3+) with the time to sputum conversion (p > 0.05). AFB sputum have significant correlation with time of culture conversion (p < 0.05), and treatment compliance was not associated with time of AFB sputum conversion (p > 0.05). There was no significant relation between positivity of AFB baseline and time to sputum conversion in DR-TB patients on short-term treatment (STR) regimen. AFB sputum have significant correlation with time of culture conversion in DR-TB patients on short-term treatment (STR) regimen.

Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis

OBJECTIVE

To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment.

METHODS

Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512.

RESULTS

A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated.

CONCLUSION

The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.

Assessment of multidrug-resistant tuberculosis (MDR-TB) treatment outcomes in Sudan; findings and implications

Background: Multidrug-resistant tuberculosis (MDR-TB) has a socioeconomic impact and threatens global public health. We assessed treatment outcomes of MDR-TB and predictors of poor treatment outcomes in Sudan given current high prevalence rates.Methods: Combined retrospective and prospective cohort study at Abu-Anga hospital (TB specialized hospital in Sudan). All patients with MDR-TB between 2013 and 2017 were targeted.Results: A total of 156 patients were recruited as having good records, 117 (75%) were male, and 152 (97.4%) had pulmonary TB. Patients were followed for a median of 18 months and a total of 2108 person-months. The overall success rate was 63.5% and the mortality rate was 14.1%. Rural residency (P < 0.05) and relapsing on previous treatments (P < 0.05) were determinants of time to poor MDR-TB treatment outcomes.Conclusion: Overall, more attention needs to be given to special MDR-TB groups that are highly susceptible to poor outcomes, i.e. rural patients. As a result, it is highly recommended to maintain total coverage of medicines for all MDR-TB patients for the entire period of treatment in Sudan. It is also recommended to instigate more treatment centers in rural areas in Sudan together with programs to enhance adherence to treatments including patient counseling to improve future outcomes.

Improved Fluoroquinolone-Resistant and Extensively Drug-Resistant Tuberculosis Treatment Outcomes

Background

Treatment outcomes of multidrug-resistant tuberculosis (MDR TB) remain poor, particularly for fluoroquinolone-resistant (FQ-R) MDR TB. The aim of this study was to determine treatment outcomes and factors associated with failure of MDR TB treatment, focusing on FQ resistance.

Methods

Medical records were retrospectively reviewed of patients diagnosed and treated for MDR TB from January 2005 through December 2017 at Severance Hospital, South Korea.

Results

Of a total of 129 patients with MDR TB, 90 (69.8%) cases were FQ-sensitive (FQ-S) and 39 (30.2%) were FQ-R. FQ-R MDR TB was associated with more severe clinical symptoms, including cavitary lesions and bilateral disease, and tended to require treatment with a greater number of drugs for a longer period of time than FQ-S MDR TB. Linezolid (51.3% vs 7.8%, P < .001), bedaquiline (20.5% vs 8.9%, P = .083), and delamanid (10.3% vs 5.6%, P = .452) were more frequently used in FQ-R cases. Overall, 95/124 patients (76.6%) had favorable treatment outcomes, and we did not detect a significant difference between FQ-R and FQ-S (FQ-S 65/87, 74.7%, vs FQ-R 30/37, 81.1%; P = .443). Old age, low body mass index, smoking, and malignancy—but not FQ resistance or extensively drug-resistant (XDR) TB—were associated with poor clinical outcomes.

Conclusions

Overall, 76.6% of MDR TB patients had successful treatment outcomes. Effective drug combinations and appropriate use of new drugs may improve treatment outcomes of FQ-R MDR and XDR TB. Poor clinical outcomes were more related to the patients’ general condition rather than FQ resistance or XDR.