Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2018 Jun 21;13(6):e0199320. doi: 10.1371/journal.pone.0199320. eCollection 2018.
In Ethiopia, Multi-drug resistant Tuberculosis (MDR-TB) is one of the major public health problems that need great attention. Time to sputum culture conversion is often used as an early predictive value for the final treatment outcome. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Ethiopia. This study was aimed at determining the time to sputum culture conversion and the determinants among MDR-TB patients at public Hospitals of the Amhara Regional State.
A retrospective follow up study was conducted between September 2010 and December 2016. Three hundred ninety two MDR-TB patients were included in the study. Parametric frailty models were fitted and Cox Snell residual was used for goodness of fit, which the Akaike's information criteria was used for model selection. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of association.
Out of the 392 participants, sputum culture changed for 340(86.7%) during the follow up period. The median culture conversion time in this study was 65 (60-70 days). Alcohol drinking (AHR = 3.79, 95%CI = 1.65-8.68), sputum smear grading +2 (AHR = 0.39, 95%CI 0.19-0.79), smear grading +3 (AHR = 0.30, CI = 0.14-064), cavitations (AHR = 0.36, 95%CI = 0.19-0.68), and consolidation (AHR = 0.29, CI = 0.13-0.69) were the determinants of time to sputum culture conversion.
In this study, time to sputum culture was rapid as compared to 4 months WHO recommendation. Alcohol drinking, sputum smear grading, cavitations and consolidations were found to be the determinants of time to sputum culture conversion. Therefore, providing a special attention to patients who had baseline radiological finding is recommended, high bacillary load and patients with a history of alcohol intake at baseline should be given priority.
在埃塞俄比亚，耐多药结核病（MDR-TB）是一个需要高度关注的主要公共卫生问题。痰培养转换时间通常被用作最终治疗结果的早期预测值。尽管经常制定 MDR-TB 指南，免费提供药物，并适当扩大治疗中心，但埃塞俄比亚对痰培养转换时间的研究非常有限。本研究旨在确定在阿姆哈拉州立地区公立医院的 MDR-TB 患者的痰培养转换时间和决定因素。
本研究为 2010 年 9 月至 2016 年 12 月进行的回顾性随访研究。共纳入 392 例 MDR-TB 患者。拟合参数脆弱模型，并使用 Cox Snell 残差进行拟合优度检验，Akaike 信息准则用于模型选择。报告调整后的危险比（AHR）及其 95%置信区间（CI）以显示关联强度。
在 392 名参与者中，在随访期间 340 名（86.7%）痰培养发生变化。本研究中培养转换的中位数时间为 65（60-70 天）。饮酒（AHR=3.79，95%CI=1.65-8.68）、痰涂片分级+2（AHR=0.39，95%CI 0.19-0.79）、涂片分级+3（AHR=0.30，CI=0.14-064）、空洞（AHR=0.36，95%CI=0.19-0.68）和实变（AHR=0.29，CI=0.13-0.69）是痰培养转换时间的决定因素。
与世界卫生组织推荐的 4 个月相比，本研究中痰培养时间较快。饮酒、痰涂片分级、空洞和实变被认为是痰培养转换时间的决定因素。因此，建议特别关注基线放射学发现的患者，优先考虑高细菌负荷和基线时有饮酒史的患者。
