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

被引：28

作者：

Lv, Lingshuang ^{[1
]}

Li, Tiecheng ^{[2
]}

Xu, Kun ^{[1
]}

Shi, Peiyi ^{[1
]}

He, Biyu ^{[1
]}

Kong, Weimin ^{[3
]}

Wang, Jianming ^{[1
]}

Sun, Jian ^{[3
]}

机构：

[1] Nanjing Med Univ, Sch Publ Hlth, Key Lab Infect Dis, Dept Epidemiol, 101 Longmian Ave, Nanjing 211166, Jiangsu, Peoples R China

[2] Fourth Peoples Hosp Lianyungang City, Dept TB, Lianyungang, Peoples R China

[3] First Peoples Hosp Yancheng City, Dept Thorac Surg, 166 Yulong West Rd, Yancheng 224001, Peoples R China

来源：

INFECTION AND DRUG RESISTANCE | 2018年 / 11卷

基金：

中国国家自然科学基金;

关键词：

multidrug-resistant tuberculosis; sputum smear conversion; sputum culture conversion; treatment outcome; prognosis; CULTURE CONVERSION; METAANALYSIS; PREDICTORS;

D O I：

10.2147/IDR.S153499

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Purpose: Multidrug-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 methods: We 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. Results: Among 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) (X-2 = 4.18, P = 0.041). Conclusion: The 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.

引用

页码：147 / 154

页数：8