Central African Journal of Public Health

| Peer-Reviewed |

Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study

Received: Dec. 20, 2019    Accepted: Jan. 04, 2020    Published: Jan. 13, 2020
Views:       Downloads:

Share This Article

Abstract

Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.

DOI 10.11648/j.cajph.20200601.15
Published in Central African Journal of Public Health ( Volume 6, Issue 1, February 2020 )
Page(s) 23-32
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Conversion, Multidrug-resistant, Tuberculosis, Guinea

References
[1] World Health Organization: Global tuberculosis report 2017. Geneva, Swizerland: WHO press, 2017.
[2] Holtz TH, Sternberg M, Kammerer S, Laserson KF, Riekstina V, Zarovska E, et al. Time to Sputum Culture Conversion in Multidrug-Resistant Tuberculosis: Predictors and Relationship to Treatment Outcome. Ann Intern Med. 2006; 144 (9): 650.
[3] Shibabaw A, Gelaw B, Wang S-H, Tessema B. Time to sputum smear and culture conversions in multidrug resistant tuberculosis at University of Gondar Hospital, Northwest Ethiopia. Cardona P-J, editor. PLOS ONE. 2018; 13 (6): e0198080.
[4] Kurbatova EV, Gammino VM, Bayona J, Becerra MC, Danilovitz M, Falzon D, et al. Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012; 16 (10): 1335–43.
[5] Liu Q, Lu P, Martinez L, Yang H, Lu W, Ding X, et al. Factors affecting time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis in China. BMC Infect Dis 2018; 18 (1).
[6] Lv L, Li T, Xu K, Shi P, He B, Kong W, et al. Sputum bacteriology conversion and treatment outcome of patients with multidrug-resistant tuberculosis. Infect Drug Resist. 2018; 11: 147–54.
[7] Park H-O, Kim S-H, Moon S-H, Byun J-H, Kim J-W, Lee C-E, et al. Association between Body Mass Index and Sputum Culture Conversion among South Korean Patients with Multidrug Resistant Tuberculosis in a Tuberculosis Referral Hospital. Infect Chemother. 2016; 48 (4): 317.
[8] Putri FA, Burhan E, Nawas A, Soepandi PZ, Sutoyo DK, Agustin H, et al. Body mass index predictive of sputum culture conversion among MDR-TB patients in Indonesia. Int J Tuberc Lung Dis. 2014; 18 (5): 564–70.
[9] Tierney DB, Franke MF, Becerra MC, Alcántara Virú FA, Bonilla CA, Sánchez E, et al. Time to Culture Conversion and Regimen Composition in Multidrug-Resistant Tuberculosis Treatment. Pai M, editor. PLoS ONE. 2014; 9 (9): e108035.
[10] Alene KA, Viney K, Yi H, McBryde ES, Yang K, Bai L, et al. Comparison of the validity of smear and culture conversion as a prognostic marker of treatment outcome in patients with multidrug-resistant tuberculosis. Hasnain SE, editor. PLOS ONE. 2018; 13 (5): e0197880.
[11] National Tuberculosis Control Program Guinea: Annual report of TB control activity, 2018.
[12] Hansen RA, Kim MM, Song L, Tu W, Wu J, Murray MD. Adherence: Comparison of Methods to Assess Medication Adherence and Classify Nonadherence. Ann Pharmacother. 2009; 43 (3): 413–22.
[13] WHO: Definitions and reporting framework for tuberculosis–2013 revision (updated 2014). Geneva: Switzerland World Health Organization; 2013.
[14] Youden WJ. Index for rating diagnostic tests. Cancer. 1950; 3 (1): 32–5.
[15] Brust JCM, Lygizos M, Chaiyachati K, Scott M, van der Merwe TL, Moll AP, et al. Culture Conversion Among HIV Co-Infected Multidrug-Resistant Tuberculosis Patients in Tugela Ferry, South Africa. Pai M, editor. PLoS ONE. 2011; 6 (1): e15841.
[16] Rodriguez M, Monedero I, Caminero JA, Encarnación M, Dominguez Y, Acosta I, et al. Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic. Int J Tuberc Lung Dis. 2013; 17 (4): 520–5.
[17] Kurbatova EV, Cegielski JP, Lienhardt C, Akksilp R, Bayona J, Becerra MC, et al. Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: a secondary analysis of data from two observational cohort studies. Lancet Respir Med. 2015; 3 (3): 201–9.
[18] Saleri N, Dembele SM, Villani P, Carvalho ACC, Cusato M, Bonkoungou V, et al. Systemic exposure to rifampicin in patients with tuberculosis and advanced HIV disease during highly active antiretroviral therapy in Burkina Faso. J Antimicrob Chemother. 2012; 67 (2): 469–72.
[19] Boeree MJ, Heinrich N, Aarnoutse R, Diacon AH, Dawson R, Rehal S, et al. High-dose rifampicin, moxifloxacin, and SQ109 for treating tuberculosis: a multi-arm, multi-stage randomised controlled trial. Lancet Infect Dis. 2017; 17 (1): 39–49.
[20] Svensson RJ, Svensson EM, Aarnoutse RE, Diacon AH, Dawson R, Gillespie SH, et al. Greater Early Bactericidal Activity at Higher Rifampicin Doses Revealed by Modeling and Clinical Trial Simulations. J Infect Dis. 2018; 218 (6): 991–9.
[21] Byrd, Jr. RP, Mehta JB, Roy TM. Malnutrition and Pulmonary Tuberculosis. Clin Infect Dis. 2002; 35 (5): 634–5.
Cite This Article
  • APA Style

    Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. (2020). Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Central African Journal of Public Health, 6(1), 23-32. https://doi.org/10.11648/j.cajph.20200601.15

    Copy | Download

    ACS Style

    Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camar; Gladys Djuiga Fotso; Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent. Afr. J. Public Health 2020, 6(1), 23-32. doi: 10.11648/j.cajph.20200601.15

    Copy | Download

    AMA Style

    Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent Afr J Public Health. 2020;6(1):23-32. doi: 10.11648/j.cajph.20200601.15

    Copy | Download

  • @article{10.11648/j.cajph.20200601.15,
      author = {Boubacar Djelo Diallo and Alhassane Diallo and Lansana Mady Camar and Gladys Djuiga Fotso and Souleymane Camara and Boubacar Bah and Magassouba Aboubacar Sidiki and Alpha Oumar Barry and Thierno Hassane Diallo and Camara Aboubacar and Néné Mamata Bah and Fulgence N’Zabintawali and Souleymane Hassane Haroune and Oumou Younoussa Sow},
      title = {Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study},
      journal = {Central African Journal of Public Health},
      volume = {6},
      number = {1},
      pages = {23-32},
      doi = {10.11648/j.cajph.20200601.15},
      url = {https://doi.org/10.11648/j.cajph.20200601.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.cajph.20200601.15},
      abstract = {Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.},
     year = {2020}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study
    AU  - Boubacar Djelo Diallo
    AU  - Alhassane Diallo
    AU  - Lansana Mady Camar
    AU  - Gladys Djuiga Fotso
    AU  - Souleymane Camara
    AU  - Boubacar Bah
    AU  - Magassouba Aboubacar Sidiki
    AU  - Alpha Oumar Barry
    AU  - Thierno Hassane Diallo
    AU  - Camara Aboubacar
    AU  - Néné Mamata Bah
    AU  - Fulgence N’Zabintawali
    AU  - Souleymane Hassane Haroune
    AU  - Oumou Younoussa Sow
    Y1  - 2020/01/13
    PY  - 2020
    N1  - https://doi.org/10.11648/j.cajph.20200601.15
    DO  - 10.11648/j.cajph.20200601.15
    T2  - Central African Journal of Public Health
    JF  - Central African Journal of Public Health
    JO  - Central African Journal of Public Health
    SP  - 23
    EP  - 32
    PB  - Science Publishing Group
    SN  - 2575-5781
    UR  - https://doi.org/10.11648/j.cajph.20200601.15
    AB  - Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.
    VL  - 6
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • National Tuberculosis Control Program, Conakry, Guinea

  • Carrière Tuberculosis Center, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • National Reference Laboratory for Mycobacteria, Conakry, Guinea

  • National Reference Laboratory for Mycobacteria, Conakry, Guinea

  • Action Damien, Conakry, Guinea

  • Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

  • Section