Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2022 Mar 9;17(3):e0264852. doi: 10.1371/journal.pone.0264852. eCollection 2022.
Sputum smear microscopy is simple and feasible technique to assess the presence of acid-fast bacilli (AFB) in the respiratory tract of patients with Drug Resistance Tuberculosis (DR-TB). Conversion of sputum smear from positive to negative is considered as an interim indicator of efficacy of anti-tubercular treatment and the program effectiveness. Although evidences regarding the factors affecting the sputum smear conversion are available on drug susceptible TB patients, there is dearth of literature about smear conversion and its predictors among DR-TB patients in the study setting. Hence, shortening the time to sputum smear conversion is desirable to reduce the likelihood of mycobacterial transmission. This study has therefore aimed at estimating the median time of sputum smear conversion and to determine its predictors.
This was a retrospective follow-up study conducted among DR-TB patients registered for second-line anti-TB treatment in the four hospitals of Amhara regional state, Northwest Ethiopia. Of all patients enrolled to DR-TB treatment in the study setting from 2010 to 2017, 436 patients have been include for this study who fulfilled the eligibility criteria. The cox proportional hazard model was fitted and the adjusted hazard ratio (AHR) with 95% confidence interval (CI) and p <0.05 was used to declare statistical significance of the variables associated with the smear conversion.
From the 436 patients with sputum smear positive at baseline, 351 (80.5%) converted sputum smear at a median time of 48 (IQR: 30-78) days. The median time of smear conversion was 59 (95% CI: 42, 74) and 44 (95% CI: 37, 54) days among patients who had and had no history of alcohol drinking, respectively. Similarly, the median time to smear conversion was 61 (95% CI: 36, 73) days among patients with comorbid conditions and 44 (95% CI: 38, 54) days among patients with no comorbid conditions. In the multi-variable analysis, only history of alcohol consumption [AHR = 0.66 (0.50, 0.87)] was found to delay significantly the rate of sputum smear conversion.
In our study, the median time of sputum smear conversion was with in the expected time frame of conversion. History of alcohol consumption was found to delay significantly the rate of sputum smear conversion. The DR-TB patients are strongly advised to avoid alcohol consumption.
痰涂片镜检是一种简单可行的技术，可用于评估耐药结核病（DR-TB）患者呼吸道中是否存在抗酸杆菌（AFB）。痰涂片由阳性转为阴性被认为是抗结核治疗效果和方案效果的一个中期指标。虽然有关于影响痰涂片转化的因素的证据，但在研究环境中，关于 DR-TB 患者痰涂片转化及其预测因素的文献却很少。因此，缩短痰涂片转化时间是减少分枝杆菌传播可能性的理想方法。因此，本研究旨在估计痰涂片转化的中位数时间，并确定其预测因素。
这是一项在埃塞俄比亚西北部阿姆哈拉州的四家医院登记接受二线抗结核治疗的 DR-TB 患者中进行的回顾性随访研究。在研究环境中，从 2010 年到 2017 年登记接受 DR-TB 治疗的所有患者中，有 436 名符合纳入标准的患者被纳入本研究。拟合了 Cox 比例风险模型，并使用调整后的风险比（AHR）及其 95%置信区间（CI）和 p<0.05 来宣布与涂片转换相关的变量的统计学意义。
在 436 名基线痰涂片阳性的患者中，有 351 名（80.5%）在中位时间 48（IQR：30-78）天转为痰涂片阴性。在有和没有饮酒史的患者中，涂片转换的中位时间分别为 59（95%CI：42，74）和 44（95%CI：37，54）天。同样，在合并症患者中，涂片转换的中位时间为 61（95%CI：36，73）天，而在无合并症患者中为 44（95%CI：38，54）天。在多变量分析中，只有饮酒史（AHR=0.66（0.50，0.87））被发现显著延迟痰涂片转换率。
在我们的研究中，痰涂片转换的中位时间在预期的转换时间范围内。饮酒史被发现显著延迟了痰涂片的转换率。DR-TB 患者应强烈避免饮酒。
