Djouma Fabrice Nembot, Noubom Michel, Ateudjieu Jérôme, Donfack Hubert
Department of Biomedical Sciences, University of Dschang, Cameroon, PO Box 067, Dschang, Cameroon.
Better Access to Health Care "MASSANTE", PO Box 33490, Yaoundé, Cameroon.
BMC Infect Dis. 2015 Mar 21;15:139. doi: 10.1186/s12879-015-0876-1.
In limited resource settings, sputum smear conversion at the end of the intensive phase of tuberculosis treatment is an indicator not only of patients' response to treatment, but also of anti-tuberculosis program performance. The objective of this study was to identify factors associated to sputum smear non-conversion at the end of the intensive phase of treatment, and the effect of smear non-conversion on the outcome of smear-positive pulmonary tuberculosis patients.
This retrospective cohort study was carried out on data of patients treated in the Diagnostic and Treatment Centre of Baleng, West-Cameroon from 2006 to 2012. Logistic regression models were used to evaluate the association of socio-demographic and clinical factors with delay in sputum smear conversion, and the association of this delay with treatment outcomes.
Out of 1425 smear-positive pulmonary tuberculosis patients treated during the study period, 1286 (90.2%) were included in the analysis. Ninety four (7.3% CI: 6.0- 8.9) patients were identified as non-converted at the end of the intensive phase of treatment. Pre-treatment smears graded 2+ and 3+ were independently associated to delay in smear conversion (p<0.01). Years of treatment ranging from 2009 to 2012 were also associated to delay in smear conversion (p<0.02). Delay in smear conversion was significantly associated to failure [Adjusted Odd Ratio (AOR):12.4 (Confidence Interval: CI 4.0- 39.0)] and death, AOR: 3.6 (CI 1.5- 9.0).
Heavy initial bacillary load and treatment years ranging from 2009 to 2012 were associated to sputum smear non-conversion at the end of the intensive phase of TB treatment. Also, delay in smear conversion was associated to unfavorable treatment outcomes. Patients with heavy initial bacillary load should thus be closely monitored and studies done to identify reasons for the high proportion of non-conversion among patients treated between 2009 and 2012.
在资源有限的环境中，结核病治疗强化期结束时痰涂片转阴不仅是患者对治疗反应的指标，也是抗结核项目绩效的指标。本研究的目的是确定与治疗强化期结束时痰涂片未转阴相关的因素，以及涂片未转阴对涂片阳性肺结核患者治疗结果的影响。
本回顾性队列研究基于2006年至2012年在喀麦隆西部巴伦诊断与治疗中心接受治疗的患者数据进行。采用逻辑回归模型评估社会人口统计学和临床因素与痰涂片转阴延迟之间的关联，以及这种延迟与治疗结果之间的关联。
在研究期间接受治疗的1425例涂片阳性肺结核患者中，1286例（90.2%）纳入分析。94例（7.3%，95%置信区间：6.0 - 8.9）患者在治疗强化期结束时被确定为未转阴。治疗前涂片分级为2+和3+与涂片转阴延迟独立相关（p<0.01）。2009年至2012年的治疗年份也与涂片转阴延迟相关（p<0.02）。涂片转阴延迟与治疗失败显著相关[调整后的优势比（AOR）：12.4（置信区间：CI 4.0 - 39.0）]和死亡相关，AOR：3.6（CI 1.5 - 9.0）。
初始菌量高以及2009年至2012年的治疗年份与结核病治疗强化期结束时痰涂片未转阴相关。此外，涂片转阴延迟与不良治疗结果相关。因此，应密切监测初始菌量高的患者，并开展研究以确定2009年至2012年接受治疗患者中未转阴比例高的原因。
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