Alzarea Abdulaziz Ibrahim, Saifullah Amna, Khan Yusra Habib, Alanazi Adullah Salah, Alatawi Ahmed D, Algarni Majed Ahmed, Almalki Ziyad Saeed, Alahmari Abdullah K, Alhassan Hassan H, Mallhi Tauqeer Hussain
Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Saudi Arabia.
Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan.
Front Pharmacol. 2024 Jun 5;15:1370344. doi: 10.3389/fphar.2024.1370344. eCollection 2024.
This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases. The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants. Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5 years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97 kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion ( < 0.001, aOR = 5.817, and 95% CI = 3.703-9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855-0.907, and < 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion ( < 0.001, aOR = 7.446, and 95% CI = 4.869-11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835-0.889, and < 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877-0.927, and < 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes. Within 2 months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.
本研究调查了耐多药肺结核（DR-PTB）病例的痰涂片和培养转阴时间及其转阴的决定因素，以及与治疗结果相关的变量。利用患者的电子数据库和书面病历评估研究参与者的社会人口学、临床、微生物学及治疗特征和结果。在736例肺结核（PTB）患者中，平均年龄为36.5±16.5岁，男性占53.4%，平均体重为47.76±11.97kg。痰涂片转阴和痰培养转阴的中位时间为1个月。第一个月的培养转阴（<0.001，调整后比值比[aOR]=5.817，95%可信区间[CI]=3.703-9.138）是痰涂片转阴的决定因素，受试者工作特征曲线分析显示曲线下面积（AUC）=0.881，95%CI=0.855-0.907，P<0.001，这表明该回归模型对初始痰涂片转阴具有较高的预测能力。然而，第一个月的痰涂片转阴（<0.001，aOR=7.446，95%CI=4.869-11.388）归因于痰培养转阴，该模型通过ROC曲线分析显示出出色的回归预测能力，AUC=0.862，95%CI=0.835-0.889，P<0.001。共有63.2%的患者治疗结果良好，63.1%的病例达到治愈状态。既往使用二线药物、吸烟史、病程≤1年、广泛耐药结核病以及第一个月痰涂片转阴是耐多药肺结核病例中观察到的良好治疗结果的相关变量。ROC曲线分析显示AUC=0.902，95%CI=0.877-0.927，P<0.001，表明该回归模型对影响治疗结果的变量具有出色的预测能力。在治疗的2个月内，大多数患者的痰培养和痰涂片已转阴。确定了早期痰涂片和痰培养转阴以及良好治疗结果的决定因素。在设计和实施耐多药结核病控制项目的有效策略时应考虑这些因素。
