Evaluation of sputum culture conversion as a prognostic marker for end-of-treatment outcome inpatients with multidrug-resistant tuberculosis

Details

• Alternative Title:
  Lancet Respir Med
• Personal Author:
  Kurbatova, Ekaterina V. ; Cegielski, J. Peter ; Lienhardt, Christian ; Akksilp, Rattanawadee ; Bayona, Jaime ; Becerra, Mercedes C. ; Caoili, Janice ; Contreras, Carmen ; Dalton, Tracy ; Danilovits, Manfred ; Demikhova, Olga V. ; Ershova, Julia ; Gammino, Victoria M. ; Gelmanova, Irina ; Heilig, Charles M. ; Jou, Ruwen ; Kazennyy, Boris ; Keshavjee, Salmaan ; Kim, Hee Jin ; Kliiman, Kai ; Kvasnovsky, Charlotte ; Leimane, Vaira ; Mitnick, Carole D. ; Quelapio, Imelda ; Riekstina, Vija ; Smith, Sarah E. ; Tupasi, Thelma ; van der Walt, Martie ; Vasilyeva, Irina A. ; Via, Laura E. ; Viiklepp, Piret ; Volchenkov, Grigory ; Walker, Allison Taylor ; Wolfgang, Melanie ; Yagui, Martin ; Zignol, Matteo
• Description:
  Background
  
  To assess the validity of sputum culture conversion (SCC) on solid media at varying time points and the time to SCC as prognostic markers for end-of-treatment outcome in multidrug-resistant (MDR) tuberculosis (TB) patients.
  
  Methods
  
  Data on1,712 MDR-TB patients from two large cohort studies were analyzed. Measures of association were determined using random effects multivariable logistic regression. Predictive values were calculated using bivariate random-effects generalized linear mixed model.
  
  Findings
  
  Times to SCC and SCC status at 6 months were significantly associated with treatment success compared to failure or death. SCC status at 2 months was significantly associated with treatment success among patients without known HIV infection only. The overall association of SCC with a successful outcome was substantially stronger at 6 months (adjusted odds ratio [aOR]=14.07, 95% CI 10.05–19.71) than at 2 months (HIV-negative patients: aOR=4.12 [2.25–7.54]; HIV unknown: aOR=3.59 [1.96–6.58], HIV-positive: aOR=0.38 [0.12–1.18]). The 2-month SCC had low sensitivity (27%) and high specificity (90%) for predicting treatment success. Conversely, 6-month SCC status had high sensitivity (92%), but moderate specificity (58%). The maximum combined sensitivity and specificity for SCC was reached between the 6th and 10th month of treatment.
  
  Interpretation
  
  Time to SCC, SCC status at 6 months, and SCC status at 2 months among patients without known HIV infection can be considered proxy markers of end-of-treatment outcome in MDR-TB patients, but the overall association with treatment success is substantially stronger for 6-month compared to 2-month SCC.
  
  Funding
  
  USAID, the US CDC, the Division of Intramural Research of NIAID/NIH, and the Republic of Korea’s CDC.
  
  
• Subjects:
  Adolescent Adult Aged Humans Middle Aged Mycobacterium Tuberculosis Prospective Studies Sputum Treatment Outcome Tuberculosis, Multidrug-Resistant Tuberculosis, Pulmonary Young Adult

  More +
• Keywords:
  Multidrug-resistant Tuberculosis Outcome Prognostic Marker Sputum Culture Conversion Treatment
• Source:
  Lancet Respir Med. 2015; 3(3):201-209
• Pubmed ID:
  25726085
• Pubmed Central ID:
  PMC4401426
• Document Type:
  Journal Article
• Funding:
  001/WHO_/World Health OrganizationInternational/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/ ; ImNIH/Intramural NIH HHSUnited States/
• Volume:
  3
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:deab06518eeed68375316c77c5792edc97ed83a09eaca4f0d35cf3d12c2d3331
• Download URL:
  https://stacks.cdc.gov/view/cdc/30521/cdc_30521_DS1.pdf
• File Type:
  [PDF - 447.74 KB ]