Holtz Timothy H, Sternberg Maya, Kammerer Steve, Laserson Kayla F, Riekstina Vija, Zarovska Evija, Skripconoka Vija, Wells Charles D, Leimane Vaira
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Ann Intern Med. 2006 May 2;144(9):650-9. doi: 10.7326/0003-4819-144-9-200605020-00008.
Conversion of sputum mycobacterial cultures from positive growth to negative growth of Mycobacterium tuberculosis in patients with pulmonary tuberculosis (TB) is considered the most important interim indicator of the efficacy of anti-TB pharmacologic treatment for multidrug-resistant disease.
To evaluate and compare time to and predictors of initial sputum culture conversion with predictors of treatment outcome for patients with multidrug-resistant TB.
Retrospective cohort study.
Latvia.
All civilian patients with multidrug-resistant TB treated with the DOTS-Plus strategy between 1 January and 31 December 2000.
Individualized treatment for confirmed sputum culture-positive pulmonary multidrug-resistant TB.
Time to initial sputum culture conversion and treatment outcome.
Among 167 patients who were sputum culture-positive at initiation of second-line therapy, 129 (77%) converted in a median time of 60 days (range, 4 to 462 days) and 38 (23%) did not convert. Independent predictors of a longer sputum culture conversion time, using an accelerated failure time regression model, included previous treatment for multidrug-resistant TB, high initial sputum culture colony count, bilateral cavitations on chest radiography, and the number of drugs the initial isolate was resistant to at treatment initiation. Treatment outcomes were statistically significantly worse for patients who did not convert their sputum culture within 2 months.
Twenty-five percent of patients missed 5 or more monthly sputum collections.
Under program conditions in Latvia, most patients with multidrug-resistant TB achieved sputum culture conversion within 12 weeks of starting treatment. Chest radiography and sputum culture drug susceptibility testing can assist physicians in predicting which patients will convert more slowly. Sputum culture conversion is a useful and appropriate interim indicator of treatment outcome in patients with multidrug-resistant TB.
肺结核（TB）患者痰液中结核分枝杆菌培养从阳性生长转为阴性生长，被认为是耐多药疾病抗结核药物治疗疗效最重要的中期指标。
评估并比较耐多药结核病患者初始痰液培养转阴时间及其预测因素与治疗结局的预测因素。
回顾性队列研究。
拉脱维亚。
2000年1月1日至12月31日期间采用强化期督导化疗（DOTS-Plus）策略治疗的所有耐多药结核病平民患者。
对确诊痰液培养阳性的耐多药肺结核进行个体化治疗。
初始痰液培养转阴时间和治疗结局。
在二线治疗开始时痰液培养阳性的167例患者中，129例（77%）在中位时间60天（范围4至462天）内转阴，38例（23%）未转阴。使用加速失效时间回归模型，痰液培养转阴时间较长的独立预测因素包括既往耐多药结核病治疗史、初始痰液培养菌落计数高、胸部X线片双侧空洞以及治疗开始时初始分离株耐药的药物数量。在2个月内痰液培养未转阴的患者治疗结局在统计学上显著更差。
25%的患者错过5次或更多次每月痰液采集。
在拉脱维亚的项目条件下，大多数耐多药结核病患者在开始治疗的12周内实现了痰液培养转阴。胸部X线片和痰液培养药物敏感性检测可帮助医生预测哪些患者转阴较慢。痰液培养转阴是耐多药结核病患者治疗结局有用且合适的中期指标。
