scholarly journals How Soon Should Patients with Smear-Positive Tuberculosis Be Released from Inpatient Isolation?

2010 ◽  
Vol 31 (1) ◽  
pp. 78-84 ◽  
Author(s):  
David J. Horne ◽  
Catherine O. Johnson ◽  
Eyal Oren ◽  
Christopher Spitters ◽  
Masahiro Narita
Keyword(s):  
Survival Analysis ◽  
Confidence Interval ◽  
Pulmonary Tuberculosis ◽  
Patient Characteristics ◽  
Hazard Ratio ◽  
Bivariate Analysis ◽  
Sputum Smear ◽  
Patient Counseling ◽  
Factors Associated ◽  
Culture Conversion

Objective.In patients with smear-positive pulmonary tuberculosis who are hospitalized or reside in congregate settings, guidelines recommend airborne infection isolation until sputum smear results are negative. Studies have identified factors associated with delayed sputum smear and culture conversion in patients with tuberculosis. Because these studies did not use methods of survival analysis, estimates of time to sputum smear conversion that are based on initial patient characteristics are not available. The ability to predict time to sputum smear conversion could be useful for programmatic planning and patient counseling.Methods.We performed a cohort study using survival analysis to identify factors associated with time to sputum smear and culture conversion. We defined the time to sputum smear conversion as the time elapsed from the start of treatment to the first date of sustained conversion.Results.Ninety-eight patients had sputum smear samples positive for acid-fast bacilli. Lower initial smear grade (on 1+ to 4+ scale) and absence of cavitation on chest radiograph were associated with earlier sputum smear conversion in bivariate analysis. In multiple regression analysis, initial smear grade (hazard ratio, 0.45; 95% confidence interval, 0.35-0.57) and drug resistance (hazard ratio, 2.30; 95% confidence interval, 1.08-4.89) remained statistically significant; a model comprising only initial smear grade performed almost as well. Predictors of sputum culture conversion were similar.Conclusions.Initial smear grade was the strongest predictor of time to sputum smear and culture conversion in patients with pulmonary tuberculosis and may be a useful predictor for programmatic planning and patient counseling.

scholarly journals Factors Influencing Sputum Smear and Culture Conversion Time among Patients with Pulmonary Tuberculosis

2018 ◽  
Vol 1 (01) ◽  
pp. 41-46
Author(s):  
Pushpa Man Shrestha ◽  
Minani Gurung ◽  
Nabin Kumar Chaudhary
Keyword(s):  
Pulmonary Tuberculosis ◽  
Erythrocyte Sedimentation Rate ◽  
Sedimentation Rate ◽  
Smoking Habit ◽  
Sputum Smear ◽  
Erythrocyte Sedimentation ◽  
Sputum Conversion ◽  
Conversion Time ◽  
Index Value ◽  
Culture Conversion

Introduction: Pulmonary tuberculosis is a contagious bacterial infection that involves the lungs and it may spread to other organs. Sputum smear and culture conversion are important indicators for the effectiveness of treatment and the infectivity of the patient. The present study aims to find sputum smear and culture conversion time and the factors that influence the conversion time among tuberculosis patients at National Tuberculosis Centre in Nepal. Methods: A total of 54 patients, who were diagnosed with laboratory confirmed pulmonary tuberculosis and under antitubercular therapy were monitored for sputum smear and culture conversion time. The blood specimens from each patient were processed for hemoglobin, platelets, erythrocyte sedimentation rate and blood glucose levels. Patient’s clinical history, risk factors that prolong conversion time and sociodemographic information were also collected by direct interview. Results: The mean sputum smear and culture conversion were found to be 54.4 days and 45.5 days respectively. Old age, smoking habit, low body mass index value, Treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate values were found to be associated with long sputum conversion time. Radiographic involvement of only left lungs, presence of fewer symptoms, aged between 15-45 years, having normal weight, without smoking habit and being married, were found to be associated with short sputum conversion time. Conclusions: The sputum microscopy, old age, smoking habit, low body mass index value, treatment category II, initial bacillary load and abnormal erythrocyte sedimentation rate value had been found to be significantly associated with long sputum conversion time.

scholarly journals 792. Number and Volume of Cavitary Lesions on Chest Computed Tomography Associated With Prolonged Time to Culture Conversion in Drug-Susceptible Pulmonary Tuberculosis

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S284-S284
Author(s):  
Alfonso Hernandez
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Chest Roentgenogram ◽  
Sputum Smear ◽  
Chest Computed Tomography ◽  
Median Difference ◽  
Cox Proportional Hazards Models ◽  
Culture Conversion

Abstract Background Cavitary lesions (CLs) may be a marker of poor treatment response in pulmonary tuberculosis (PTB). Identification of CLs by chest roentgenogram (CXR) has important limitations. Chest computed tomography (CT) is more sensitive than CXR to detect CLs but the clinical relevance of CLs identified by CT remains understudied. We compared detection of CLs between CT and CXR and assessed their association with time to sputum culture conversion (tSCC). We hypothesized that increasing number and volume of CLs on CT would be associated with prolonged tSCC. Methods Retrospective cohort study of 141 culture confirmed PTB patients who underwent chest CT. We used multivariate Cox proportional hazards models to evaluate the association between chest radiological features and tSCC. Results Seventy-five (53%) patients had one or more CLs on CT. CT identified cavities in 31% of patients without a CL on CXR. Detection of cavity on CT was associated with an increased median [IQR] time to culture conversion (15 [7–35] days among noncavitary CT vs. 39 [25–55] days among cavitary CT; P < 0.0001). Among patients without CL on CXR, detection of CL on CT was associated with prolonged tSCC (median difference (CI): 16 (7–25) days, P = 0.0008). Similar results were observed among patients with 3–4+ sputum smear (median difference: 19.5 (8–31) days, P = 0.001). Adjusted Kaplan–Meier curves of number and volume of CLs and tSCC are shown in Figure 1. After confounder adjustment patients with single and multiple CL had a prolonged tSCC relative to patients without CLs on CT (adjusted Hazard Ratio [aHR] 0.56 (0.32–0.97) and 0.31 (0.16–0.60), respectively). Similarly, patients with CL volume 25 mL or more had a prolonged tSCC (aHR 0.39 (0.21–0.72)). CXR CL was not associated with prolonged tSCC. Conclusion We observed a dose–response relationship between increasing number and volume of CLs on CT and delayed tSCC independent of sputum bacillary load. Our findings highlight a role for CT in a clinical research setting to predict shorter time to culture conversion. Disclosures All authors: No reported disclosures.

The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study

2019 ◽  
Vol 21 (4) ◽  
pp. 490-496 ◽  
Author(s):  
Patrick Saliba ◽  
Guillermo Cuervo ◽  
Ana Hornero ◽  
Gabriella De Carli ◽  
Alessandra Marani ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dwell Time ◽  
Venous Catheter ◽  
Hazard Ratio ◽  
Intervention Period ◽  
Peripheral Venous Catheter ◽  
Factors Associated ◽  
Before And After ◽  
Quasi Experimental ◽  
Catheter Failure

Background: Short peripheral venous catheters are one of the most frequently used devices in hospitals. Peripheral venous catheter failure, defined as the unscheduled dysfunction of peripheral venous catheter, is common and frequently entails a new invasive procedure. Flushing the catheter maintains patency and could prolong peripheral venous catheter dwell time. The introduction of pre-filled saline flushing syringes as compared to manually filled saline flushing syringes could facilitate the frequency of catheter flushing, and subsequently it could reduce peripheral venous catheter failure rate. Objective: To demonstrate differences in overall peripheral venous catheter failure rates before and after the introduction of pre-filled saline flushing syringes and to assess the risk factors for peripheral venous catheter failure. Methods: Quasi-experimental design, before-and-after intervention study. Intervention: introduction of pre-filled saline syringes for flushing. Multicenter study conducted in medical and surgical wards of three European hospitals during a 9-month period (4 months pre-intervention, 5 months intervention). A multivariate Cox proportional model was used to identify factors associated with the occurrence of peripheral venous catheter failure. Results: Data from 3853 peripheral venous catheters in 1915 patients were analyzed. Compared to pre-intervention period, a significant decrease in peripheral venous catheter failure rate was observed in the intervention period (57% vs 43.4%, p < 0.001). Independent factors associated with peripheral venous catheter failure were as follows: Charlson score ⩾4 (hazard ratio: 1.648; 95% confidence interval: 1.069–2.527), days of hospital stay ⩾10 (hazard ratio: 1.468; 95% confidence interval: 1.172–1.837), and catheter “D” (hazard ratio: 1.758; 95% confidence interval: 1.058–2.919). Conclusion: The use of pre-filled saline syringes significantly reduced peripheral venous catheter failure and increased catheter dwell time. Thus, it is important to reinforce the use of the pre-filled syringes for flushing to reduce the incidence of peripheral venous catheters’ failure.

scholarly journals Factors associated with time to sputum culture conversion of rifampicin-resistant tuberculosis patients in Klaipeda, Lithuania in 2016-2019: a cohort study

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Saulius Diktanas ◽  
Oleksandr Korotych ◽  
Yuliia Sereda ◽  
Ogtay Gozalov ◽  
Olga Rubcova ◽  
...  
Keyword(s):  
Cox Regression ◽  
Treatment Success ◽  
Scale Up ◽  
Secondary Analysis ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Culture Positive ◽  
Culture Conversion

The global proportion of successful treatment outcomes of Multidrug-Resistant/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) remains unacceptably low. Time to culture conversion is important in making treatment-related decisions and is used as an interim predictor of pulmonary MDR/RR-TB treatment success. No previous studies have been conducted to assess determinants of time to culture conversion for MDR/RR-TB patients in Lithuania. Secondary analysis of data of culture-positive MDR/RR-TB patients, treated in Republican Klaipeda Hospital between 1st July 2016 and 1st July 2019 was performed. Culture conversion was defined as two consecutive negative cultures on solid media submitted at least 30 days apart. Factors associated with culture conversion were estimated by crude and multivariable Cox regression accounting for competing risks. In total, 115 consecutive patients starting treatment were included in the study. Of them, the majority was male (86/115; 74.8%) with a mean age of 48 (standard deviation (SD) ±12) years and Human Immunodeficiency Virus (HIV) negative (105/115; 91.3%). Nearly two-thirds (72/115; 62.6%) had XDR (extensive drug resistance) or MDR/RR-TB with additional resistance to second-line injectables or fluoroquinolones. Of 115 culture-positive patients at baseline, 103 (89.6%) patients achieved culture conversion during 12 months of treatment. The median time to culture conversion was 1.1 months (interquartile range: 0.9-1.8). Patients aged ≥60 years compared with <40 years [adjusted hazard ration (aHR): 0.40, 95% confidence interval (CI): 0.18-0.86], smokers (aHR: 0.39, 95% CI: 0.2-0.73), patients with positive sputum smear microscopy at baseline (aHR: 0.40, 95% CI: 0.25-0.63), cavities on initial chest X-ray (aHR: 0.56, 95% CI: 0.35-0.88) and resistance to at least one fluoroquinolone drug (aHR: 0.52, 95% CI: 0.32-0.84) were slower to culture convert. In conclusion, we recommend providing additional counseling, treatment adherence interventions and scale up the use of new and repurposed TB drugs to patient groups at risk of worse interim treatment outcome: patients aged 60 and above, with resistance to fluoroquinolones, smear–positive, smokers, or with signs of extensive disease evident on initial chest radiography.

scholarly journals Factors associated with sputum culture conversion in patients with pulmonary tuberculosis

Medicina ◽  
2017 ◽  
Vol 53 (6) ◽  
pp. 386-393 ◽  
Author(s):  
Greta Musteikienė ◽  
Skaidrius Miliauskas ◽  
Jurgita Zaveckienė ◽  
Marius Žemaitis ◽  
Astra Vitkauskienė
Keyword(s):  
Pulmonary Tuberculosis ◽  
Sputum Culture ◽  
Sputum Culture Conversion ◽  
Factors Associated ◽  
Culture Conversion

scholarly journals Plasma chemokines are baseline predictors of unfavorable treatment outcomes in pulmonary tuberculosis

2020 ◽  
Author(s):  
Nathella P Kumar ◽  
Kadar Moideen ◽  
Arul Nancy ◽  
Vijay Viswanathan ◽  
Kannan Thiruvengadam ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Outcomes ◽  
Validation Cohort ◽  
High Sensitivity ◽  
Sputum Smear ◽  
Newly Diagnosed ◽  
Characteristic Analysis ◽  
Increased Risk ◽  
Culture Positive ◽  
Culture Conversion

Abstract Background Plasma chemokines are biomarkers of greater disease severity, higher bacterial burden and delayed sputum culture conversion in pulmonary tuberculosis (PTB). Whether plasma chemokines could also serve as biomarkers of unfavorable treatment outcomes in PTB is not known. Methods A cohort of newly diagnosed, sputum smear and culture positive adult individuals with drug-sensitive PTB were recruited under the Effect of diabetes on Tuberculosis Severity study in Chennai, India. Plasma chemokine levels measured before treatment initiation were compared between 68 cases with unfavorable outcomes (treatment failure, death or recurrence) and 136 control individuals who had recurrence-free cure. A second validation cohort comprising of newly diagnosed, culture positive adults with drug-sensitive TB was used to measure plasma chemokine levels in 20 cases and 40 controls. Findings Six chemokines (CCL2, CCL3, CCL4, CXCL8, CXCL10 and CX3CL1) were associated with increased risk, while CXCL1 was associated with decreased risk of unfavorable outcomes in unadjusted and adjusted analyses in the test cohort. Similarly, CCL3, CXCL8 and CXCL10 were associated with increased risk of unfavorable treatment outcomes in the validation cohort. Receiver operating characteristic analysis revealed combinations of CCL3, CXCL8 and CXCL10 exhibited very high sensitivity and specificity in differentiating cases versus controls. Conclusions Our study reveals a plasma chemokine signature that can be used as a novel biomarker for predicting adverse treatment outcomes in PTB.

scholarly journals 794. Infectivity of Smear-Positive Pulmonary TB After 2 Weeks of Rifampicin-based Anti-Tuberculous Therapy

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S285-S286
Author(s):  
Faraj Alhowady ◽  
Nada Elmaki ◽  
Maisa Ali ◽  
Ahmad Husain ◽  
Muna Al-Maslamani ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Conversion Rate ◽  
Clinical Characteristics ◽  
Communicable Disease ◽  
Sputum Culture ◽  
Sputum Smear ◽  
P Value ◽  
Duration Of Symptoms ◽  
Pulmonary Tb ◽  
Culture Conversion

Abstract Background Pulmonary tuberculosis (TB) remains one of the leading infectious causes of morbidity and mortality worldwide. Most data showed that infectiousness of pulmonary TB diminishes rapidly after 2 weeks of effective anti-tuberculous therapy and the bacilli seen in the smear after 2 weeks are most likely nonviable. We aim to assess this hypothesis by doing sputum culture after 2 weeks of therapy to assess the viability of the bacilli in the smear. Methods A prospective cohort study was conducted on patients admitted to Communicable Disease Centre (CDC), Qatar with smear positive pulmonary tuberculosis during the period November 2013–November 2014. We repeated sputum smear and culture after 2 weeks of rifampicin based regimen to assess the infectivity. Demographic and clinical characteristics of patients was evaluated and compared with smear and culture conversion rate. Results Ninety-five cases were included in the study. All had sputum smear and culture after 2 weeks of supervised rifampicin based therapy (Table 1). Sputum culture at two weeks of treatment was positive in 91 cases (95.7%) and only four cases were culture negative after 2 weeks. Demographic and clinical characteristics were compared with the culture status after 2 weeks, found Patient from Indian subcontinent and symptoms duration more than 1 month are less likely to clear infection after 2 weeks with P-value 0.01 and 0.009, respectively (Table 2). The calculated mean for sputum smear and culture conversion rate was 4 and 8 weeks, respectively. The presence of cough and the duration of symptoms were associated significantly with rapid sputum conversion (P &lt; 0.05); however, the presence of cavity on CXR had no statistical significant effect (Table 3). Conclusion Majority of our patients in the study have positive TB culture after two weeks of rifampicin based anti-tuberculosis therapy. So, discontinuation of the isolation after 2 weeks of treatment assuming that bacilli in the smear are nonviable may not be safe. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document