Department of Pulmonology, National Tuberculosis Control Center, Sanothimi, Bhaktapur, Nepal.
Department of Reference Lab, National Tuberculosis Control Center, Sanothimi, Bhaktapur, Nepal.
JNMA J Nepal Med Assoc. 2021 Nov 15;59(243):1090-1093. doi: 10.31729/jnma.7020.
Sputum non-conversion is smear positive tuberculosis despite anti-tubercular therapy. Various factors may lead to sputum non-conversion including resistance to anti-tubercular drugs, age, gender, disease severity, non-compliance, drugs unavailability etc. Little is known and studied about the contribution of these individual factors. Our study sought to determine the prevalence of sputum smear non-conversion in patients at the end of intensive phase of tuberculosis treatment visiting a tertiary-level institution in Nepal.
A descriptive cross-sectional study was conducted among recorded data of patients undergoing sputum Acid Fast Bacilli staining at the end of intensive phase at National Tuberculosis Control Center from April 2018 to April 2020. The study was approved by Nepal Health Research Council (Registration no: 76012020 P). The convenient sampling method was adopted. The data were analyzed using Microsoft Excel. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.
Our study found that out of 830 samples that were tested by Acid Fast Bacilli stain at the end of intensive phase, 40 (4.82%) (3.37-6.28 at 95% Confidence Interval) were sputum smear non-converters. The mean age of sputum non-converters was 41.25±15.543 years.
The study shows that a significant proportion of patients remain acid-fast stain positive despite the treatment. However, the proportion is low compared to other similar studies around the globe. This study provides program managers with evidence to support the development of more tailored tuberculosis care and need to conduct more intensive studies about various factors that may lead to non-conversion.
尽管进行了抗结核治疗，但痰培养仍为阳性，即痰不转阴。导致痰不转阴的因素很多，包括对结核药物的耐药性、年龄、性别、疾病严重程度、不遵医嘱、药物不可及等。这些个体因素的影响知之甚少，也鲜有研究。本研究旨在确定尼泊尔一家三级医疗机构结核强化治疗期末痰涂片不转阴患者的患病率。
本研究为描述性横断面研究，纳入 2018 年 4 月至 2020 年 4 月在国家结核病控制中心接受痰抗酸杆菌染色检查的患者记录数据。本研究获得了尼泊尔健康研究委员会的批准（注册号：76012020 P）。采用便利抽样法，使用 Microsoft Excel 进行数据分析。计算了 95%置信区间的点估计值以及二分类数据的频率和比例。
本研究发现，在 830 例强化期末经抗酸染色检测的样本中，40 例（4.82%）（95%置信区间为 3.37-6.28）为痰涂片不转阴者。痰不转阴者的平均年龄为 41.25±15.543 岁。
本研究表明，尽管进行了治疗，但仍有相当一部分患者痰抗酸染色阳性。然而，与全球其他类似研究相比，这一比例较低。本研究为项目管理人员提供了证据，支持制定更适合结核病患者的护理方案，并需要对可能导致不转阴的各种因素进行更深入的研究。
