Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study

Published: January 14, 2021
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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.

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Citations

WHO. Global tuberculosis report 2019. Geneva: World Health Organization; 2019. Accessed on: 2019 Nov 21. Available from: https://www.who.int/tb/publications/global_report/en/
Migliori GB, Tiberi S, Zumla A, et al. MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network. Int J Infect Dis 2020;92:S15–25.
Borisov SE, Dheda K, Enwerem M, et al. Effectiveness and safety of bedaquiline containing regimens in the treatment of MDR- and XDR-TB: A multicentre study. Eur Respir J 2017;49:1700387.
WHO. Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Resistant Tuberculosis Treatment. Geneva: World Health Organization; 2020. Accessed on 2020 Aug 7. Available from: https://www.who.int/publications/i/item/9789240007048
Bastard M, Sanchez-Padilla E, Hayrapetyan A, et al. What is the best culture conversion prognostic marker for patients treated for multidrug-resistant tuberculosis? Int J Tuberc Lung Dis 2019;23:1060-7.
Velayutham B, Nair D, Kannan T, et al. Factors associated with sputum culture conversion in multidrugresistant pulmonary tuberculosis. Int J Tuberc Lung Dis 2016;20:1671–6.
Yihunie Akalu T, Fentahun Muchie K, Alemu Gelaye K. Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study. PLoS One 2018;13:e0199320.
Shibabaw A, Gelaw B, Wang SH, Tessema B. Time to sputum smear and culture conversions in multidrug resistant tuberculosis at university of Gondar hospital, northwest Ethiopia. PLoS One 2018;13:e0198080.
Tang S, Yao L, Hao X, et al. Efficacy, safety and tolerability of linezolid for the treatment of XDR-TB: A study in China. Eur Respir J 2015;45:161-70.
Gler MT, Skripconoka V, Sanchez-Garavito E, et al. Delamanid for multidrug-resistant pulmonary tuberculosis. N Engl J Med 2012;366:2151-60.
Diacon AH, Pym A, Grobusch MP, et al. Multidrug-resistant tuberculosis and culture conversion with bedaquiline. N Engl J Med 2014;371:723-32.
Official Statistics Portal [Internet]. Statistical factors analysis of Lithuania. Available from: https://osp.stat.gov.lt/statistiniu-rodikliu-analize?indicator=S3R166#/
WHO. Lithuania, WHO tuberculosis profile. Geneva: World Health Organization. Available from: https://www.who.int/tb/country/data/profiles/en/
WHO. Definitions and reporting framework for tuberculosis. Geneva: World Health Organization; 2015. Available from: https://www.who.int/tb/publications/definitions/en/
Liu Q, Lu P, Martinez L, et al. Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China. BMC Infect Dis 2018;18:114.
Qazi F, Khan U, Khowaja S, et al. Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan. Int J Tuberc Lung Dis 2011;15:1556–9.
Lu P, Liu Q, Martinez L, et al. Time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis: A prospective cohort study from urban China. Eur Res J 2017;49.
Guglielmetti L, Le Dû D, Jachym M, et al. Compassionate use of bedaquiline for the treatment of multidrug-resistant and extensively drug-resistant tuberculosis: Interim analysis of a French cohort. Clin Infect Dis 2014;60:188-94.
Rishi S, Sinha P, Malhotra B, Pal N. A comparative study for the detection of mycobacteria by BACTEC MGIT 960, Lowenstein Jensen media and direct AFB smear examination. Indian J Med Microbiol 2007;25:383–6.
Ahmad N, Ahuja SD, Akkerman OW, et al. Treatment correlates of successful outcomes in pulmonary multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet 2018;392:821–34.
Salindri AD, Kipiani M, Kempker RR, et al. Diabetes reduces the rate of sputum culture conversion in patients with newly diagnosed multidrug-resistant tuberculosis. Open Forum Infect Dis 2016;3:ofw126.
Lin HH, Ezzati M, Chang HY, Murray M. Association between tobacco smoking and active tuberculosis in Taiwan: Prospective cohort study. Am J Respir Crit Care Med 2009;180:475-80.
Raviglione M, Poznyak V. Targeting harmful use of alcohol for prevention and treatment of tuberculosis: A call for action. Eur Res J 2017;50:1700946.

How to Cite

Diktanas, Saulius, Oleksandr Korotych, Yuliia Sereda, Ogtay Gozalov, Olga Rubcova, and Jay Achar. 2021. “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 91 (1). https://doi.org/10.4081/monaldi.2021.1675.