Hosu Mojisola Clara, Faye Lindiwe Modest, Apalata Teke
Department of Laboratory Medicine and Pathology, Faculty of Medicine and Health Sciences, Walter Sisulu University, Private Bag X5117, Mthatha 5099, South Africa.
Pathogens. 2025 Apr 30;14(5):441. doi: 10.3390/pathogens14050441.
Sputum culture and smear conversion are key indicators of treatment response in drug-resistant tuberculosis (DR-TB). This study aimed to assess sputum conversion and regimen efficacy among DR-TB patients and identify factors influencing conversion rates.
This retrospective cohort study analyzed medical records of DR-TB patients treated between 2018 and 2020 in the Eastern Cape Province, South Africa. Kaplan-Meier curves, Spearman correlation, and logistic regression models were used to assess time-to-sputum conversion and its predictors.
Among the 88% of patients who achieved sputum conversion, the median time ranged from 29 to 59 days. Patients on short treatment regimens converted significantly faster than those on long regimens ( = 7.55 × 10), with 90% of short-regimen patients achieving favorable outcomes compared to 52% in the long regimen group ( = 0.0000040). Spearman correlation revealed a weak but significant positive association between comorbidities and conversion time (r = 0.041, = 0.041). HIV-positive patients had a slower conversion rate than HIV-negative patients, but this association was not statistically significant (χ = 0.426, = 0.514). Logistic regression identified older age as a predictor of favorable outcomes (coefficient = 0.039, = 0.045), while regimen type and HIV status did not show significant predictive power.
Shorter treatment regimens significantly improve sputum conversion rates and treatment outcomes. The findings support optimizing DR-TB treatment through personalized regimens based on patient health status and drug resistance patterns. This study provides evidence to enhance TB control efforts in high-burden regions, with implications for global treatment strategies.
痰培养和涂片转阴是耐多药结核病（DR-TB）治疗反应的关键指标。本研究旨在评估耐多药结核病患者的痰涂片转阴情况和治疗方案疗效，并确定影响转阴率的因素。
这项回顾性队列研究分析了2018年至2020年在南非东开普省接受治疗的耐多药结核病患者的病历。采用Kaplan-Meier曲线、Spearman相关性分析和逻辑回归模型来评估痰涂片转阴时间及其预测因素。
在实现痰涂片转阴的88%的患者中，中位时间为29至59天。接受短程治疗方案的患者痰涂片转阴明显快于接受长程治疗方案的患者（=7.55×10），90%的短程治疗方案患者取得了良好的治疗效果，而长程治疗方案组这一比例为52%（=0.0000040）。Spearman相关性分析显示，合并症与转阴时间之间存在微弱但显著的正相关（r=0.041，=0.041）。HIV阳性患者的转阴率低于HIV阴性患者，但这种关联无统计学意义（χ=0.426，=0.514）。逻辑回归分析确定年龄较大是治疗效果良好的预测因素（系数=0.039，=0.045），而治疗方案类型和HIV状态未显示出显著的预测能力。
较短的治疗方案可显著提高痰涂片转阴率和治疗效果。这些研究结果支持根据患者健康状况和耐药模式制定个性化治疗方案，以优化耐多药结核病的治疗。本研究为加强高负担地区的结核病防控工作提供了证据，对全球治疗策略具有重要意义。
