时间到痰涂片和培养转换耐多药结核在贡德尔大学医院，埃塞俄比亚西北部。
Time to sputum smear and culture conversions in multidrug resistant tuberculosis at University of Gondar Hospital, Northwest Ethiopia.
机构信息
Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Internal Medicine, Division of Infectious Diseases, The Ohio State University, Columbus, Ohio, United States of America.
出版信息
PLoS One. 2018 Jun 26;13(6):e0198080. doi: 10.1371/journal.pone.0198080. eCollection 2018.
BACKGROUND
Sputum smear and culture conversions are an important indicator of treatment efficacy and help to determine treatment duration in multidrug resistant tuberculosis (MDR-TB) patients. There are no published studies of sputum smear and culture conversion of MDR-TB patients in Ethiopia. The objective of this study is to evaluate and compare time to initial sputum smear and culture conversion and to identify factors influencing time to culture conversion.
METHODS
A retrospective cohort study was conducted among all culture positive and rifampicin mono resistant (RR) or MDR-TB patients from September 2011 to August 2016 at University of Gondar Hospital. Sputum cultures were collected monthly and conversion was defined as two consecutive negative cultures taken at least 30 days apart. Data were entered using EpiData and exported to SPSS software for analysis. Cox proportional hazard model was used to determine the predictor variables for culture conversion.
RESULTS
Overall, 85.5% (201/235) of the patients converted their cultures in a median of 72 days (inter-quartile range: 44-123). More than half (61.7%) of patients achieved culture conversion within three months. The median time for sputum smear conversion was 54 days (inter-quartile range: 31-72). The median time to culture conversion among HIV positive patients was significantly shorter at 67 days (95% CI, 55.4-78.6) compared to HIV negative patients, 77 days (95% CI, 63.9-90, p = 0.005). Independent predictors of significantly longer time to sputum culture conversion were underweight (aHR = 0.71, 95% CI, 0.52-0.97), HIV negative (aHR = 0.66, 95% CI, 0.47-0.94) and treatment regimen composition (aHR = 0.57, 95% CI, 0.37-0.88). Significantly higher rate of culture conversion was observed in 2015 (aHR = 1.86, 95% CI, 1.1-3.14) and in 2016 (aHR = 3.7, 95% CI, 1.88-7.35) years of treatment compared to 2011.
CONCLUSIONS
Majority of patients achieved sputum culture conversion within three months and smear conversion within two months. Patients with identified risk factors were associated with delayed culture conversion. These factors should be considered during management of MDR-TB patients.
背景
痰涂片和培养转换是治疗效果的重要指标，有助于确定耐多药结核病（MDR-TB）患者的治疗持续时间。埃塞俄比亚尚无 MDR-TB 患者痰涂片和培养转换的发表研究。本研究旨在评估和比较初始痰涂片和培养转换时间，并确定影响培养转换时间的因素。
方法
这是一项回顾性队列研究，纳入了 2011 年 9 月至 2016 年 8 月在贡德尔大学医院就诊的所有培养阳性和利福平单耐药（RR）或 MDR-TB 患者。每月采集痰培养，连续两次阴性培养至少间隔 30 天定义为培养转换。数据使用 EpiData 录入，然后导出到 SPSS 软件进行分析。Cox 比例风险模型用于确定培养转换的预测变量。
结果
总体而言，85.5%（201/235）的患者在中位数为 72 天（四分位距：44-123）时培养转为阴性。超过一半（61.7%）的患者在三个月内实现了培养转换。痰涂片转换的中位数时间为 54 天（四分位距：31-72）。HIV 阳性患者的培养转换中位时间明显短于 HIV 阴性患者，为 67 天（95%CI，55.4-78.6），而 HIV 阴性患者为 77 天（95%CI，63.9-90，p=0.005）。痰培养转换时间显著延长的独立预测因素包括体重不足（aHR=0.71，95%CI，0.52-0.97）、HIV 阴性（aHR=0.66，95%CI，0.47-0.94）和治疗方案组成（aHR=0.57，95%CI，0.37-0.88）。与 2011 年相比，2015 年（aHR=1.86，95%CI，1.1-3.14）和 2016 年（aHR=3.7，95%CI，1.88-7.35）治疗年份观察到更高的培养转换率。
结论
大多数患者在三个月内痰培养转为阴性，两个月内痰涂片转为阴性。有明确危险因素的患者与培养转换延迟有关。在管理 MDR-TB 患者时应考虑这些因素。
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