Pefura-Yone Eric Walter, Kengne André Pascal, Kuaban Christopher
Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
BMC Infect Dis. 2014 Mar 11;14:138. doi: 10.1186/1471-2334-14-138.
We investigated the determinants of sputum culture non-conversion following intensive phase of treatment, and assessed the effects on the outcome among patients treated for a first episode of smear positive tuberculosis (TB).
This was a prospective cohort study spanning October 2009 to May 2012, among patients treated for a first episode of smear positive pulmonary tuberculosis in the Chest service of the Yaounde Jamot Hospital, Cameroon. Logistic regressions models were used to relate baseline characteristics with non-conversion of sputum cultures after the intensive phase of treatment.
A total of 953 patients were admitted to the service during the study period, including 97 (10.2%) who had a positive sputum smear at the end of the intensive phase of anti-tuberculosis treatment. Eighty-six patients with persistent of smear positive sputa at the end of intensive phase of TB treatment were included, among whom 46 (53%) had positive sputum culture for Mycobacterium tuberculosis (C+). The absence of haemoptysis [adjusted odd ratio 4.65 (95% confidence intervals: 1.14-18.95)] and current smoking [7.26 (1.59-33.23)] were the main determinants of sputum culture non-conversion. Of the 46C + patients, 7 (15%) were resistant to at least one anti-tuberculosis drug. Treatment failure rate was 28% among C + patients and 8% among C- patients (p = 0.023). The sensitivity and specificity were 78.6% and 55.4% for culture non-conversion after intensive treatment, in predicting anti-TB treatment failure.
Failure rate is high among patients with positive sputum culture after intensive treatment, even in the absence of multi-drug resistant bacilli. Treatment should be closely monitored in these patients and susceptibility to anti-tuberculosis drugs tested in the presence of persistent positive smears following the intensive phase of treatment.
我们调查了强化期治疗后痰培养未转阴的决定因素，并评估了其对初发涂片阳性肺结核（TB）患者治疗结局的影响。
这是一项前瞻性队列研究，时间跨度为2009年10月至2012年5月，研究对象为喀麦隆雅温得贾莫特医院胸科接受初发涂片阳性肺结核治疗的患者。采用逻辑回归模型将基线特征与强化期治疗后痰培养未转阴情况相关联。
研究期间共有953例患者入院，其中97例（10.2%）在抗结核治疗强化期结束时痰涂片呈阳性。纳入了86例在结核病治疗强化期结束时痰涂片持续阳性的患者，其中46例（53%）痰培养结核分枝杆菌阳性（C+）。无咯血[调整后的比值比为4.65（95%置信区间：1.14 - 18.95）]和当前吸烟[7.26（1.59 - 33.23）]是痰培养未转阴的主要决定因素。在46例C+患者中，7例（15%）对至少一种抗结核药物耐药。C+患者的治疗失败率为28%，C-患者为8%（p = 0.023）。强化治疗后痰培养未转阴预测抗结核治疗失败的敏感性和特异性分别为78.6%和55.4%。
强化治疗后痰培养阳性患者的失败率较高，即使不存在多重耐药杆菌。应对这些患者进行密切监测，并在强化期治疗后痰涂片持续阳性时检测其对抗结核药物的敏感性。
