O9‐5: Factors affecting time to sputum culture conversion with drug resistant tuberculosis using short‐term and longer regimen in Indonesia

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.Results: The median age was 38 years (interquartile range 31–47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96–0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03–0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51–1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19–0.69) were predictive of longer TTSCC.Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early.

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Factors associated with culture conversion among adults treated for pulmonary extensively drug-resistant tuberculosis during 2018-2019 in the Russian Federation: an observational cohort study

Monaldi Archives for Chest Disease ◽

10.4081/monaldi.2021.1678 ◽

2021 ◽

Vol 91 (1) ◽

Author(s):

Anastasiia Russkikh ◽

Oleksandr Korotych ◽

Yuliia Sereda ◽

Anastasia Samoilova ◽

Jay Achar ◽

...

Keyword(s):

Russian Federation ◽

Sputum Culture ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Sputum Culture Conversion ◽

Treatment Regimens ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

The Russian Federation ◽

Culture Conversion

Treatment outcomes for Multidrug/Rifampicin-Resistant Tuberculosis (MDR/RR-TB) and Extensively Drug-Resistant Tuberculosis (XDR-TB) remain poor across the globe and in the Russian Federation. Treatment of XDR-TB is challenging for programmes and patients often resulting in low success rates and onward transmission of drug-resistant strains. Analysis of factors affecting culture conversion rate among XDR-TB patients may serve as a basis for optimization of treatment regimens. We conducted a retrospective cohort study using health records from 54 patients with pulmonary XDR-TB treated at a tertiary level facility in the Russian Federation. The study population included adult patients with culture-positive pulmonary XDR-TB who started treatment between 1 January 2018-30 June 2019. Culture conversion was defined as two consecutive negative cultures, collected at least 30 days apart. The date of sputum culture conversion was taken from the first of two consecutive negative sputum cultures fulfilling these criteria. We measured time to culture conversion using cumulative incidence functions accounting for competing risks and applied binary cause-specific Cox regressions to assess associated factors. Sputum culture conversion was recorded for 43 (79.6%) patients. Median time to culture conversion adjusted for competing risk of loss to follow up was 4 months [95% confidence interval (CI): 2–5]. The number of patients who had culture converted by treatment months 2, 4, and 6 were 12 (22%), 29 (54%) and 38 (70%) respectively. In unadjusted analysis, positive baseline sputum smear microscopy [hazard ratio (HR): 0.34, 95% CI: 0.18-0.66; p=0.001), hepatitis C (HR: 0.35, 95% CI: 0.14-0.89; p=0.023], and human immunodeficiency virus (HR: 0.30 95%, CI: 0.09-0.97; p=0.045), and receipt of fewer than 4 effective drugs in the treatment regimen (HR: 0.13, 95% CI: 0.03-0.60; p=0.009) were associated with delayed culture conversion. When compared to their combined use, patients receiving regimens with bedaquiline only (HR: 0.12, 95% CI: 0.03-0.49; p=0.003) or linezolid only (HR: 0.21, 95% CI: 0.06-0.69; p=0.010) were less likely to achieve timely culture conversion. Factors delaying sputum culture conversion should be considered in the management of patients with XDR-TB and considered by clinicians for regimen design and treatment strategies. Our study outlines the importance of simultaneous inclusion of bedaquiline and linezolid in treatment regimens for patients with XDR-TB to reduce time to sputum conversion and increase treatment success.

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Liaison of Sugar Control With Time to Sputum Culture Conversion in Multi-Drug Resistant Tuberculosis

Cureus ◽

10.7759/cureus.9395 ◽

2020 ◽

Author(s):

Saira Jafri ◽

Naseem Ahmed ◽

Nausheen Saifullah ◽

Nadia Jawad ◽

Intisar A Siddiqui

Keyword(s):

Sputum Culture ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Sputum Culture Conversion ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Culture Conversion

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Bedaquiline in the treatment of multidrug- and extensively drug-resistant tuberculosis in China

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.19.0586 ◽

2020 ◽

Vol 24 (8) ◽

pp. 789-794

Author(s):

X. Han ◽

X. Chen ◽

W. Sha ◽

X. Zhang ◽

L. Qiu ◽

...

Keyword(s):

Sputum Culture ◽

Chinese Patients ◽

Drug Resistant ◽

Open Label ◽

Drug Induced ◽

Drug Resistant Tuberculosis ◽

Sputum Culture Conversion ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Culture Conversion

BACKGROUND: Multidrug- and extensively drug-resistant tuberculosis (MDR/XDR-TB) continues to be a challenge in China. Bedaquiline (BDQ) is associated with accelerated sputum culture conversion and favourable treatment outcomes when added to a preferred background regimen. This post-hoc study aimed to assess the outcomes of BDQ treatment in Chinese patients with MDR/XDR-TB.METHODS: Data from 51 Chinese patients who participated in a global Phase 2, open-label, single-arm study (TMC207-C209) were analysed for effectiveness and safety of the BDQ-containing regimen.RESULTS: During the 24-week BDQ treatment, adverse events (AEs) occurred in 48 patients (94.1%), with the most common AE being hyperuricemia. Drug-induced liver injury (DILI) was reported in 13 patients (25.5%); serious DILI was reported in one patient (2.0%). Seven (13.7%) AEs were considered to be possibly related to BDQ by the investigators. Only one Grade 1 QTc prolongation was reported; no QTcF >500 ms was reported. One death occurred after BDQ treatment due to progressive TB. The median time to sputum culture conversion was 85 days based on the 24-week data. The sputum culture conversion rate was 82% at 24 weeks and 78% at 120 weeks; 66% of patients achieved a cure.CONCLUSIONS: BDQ was well-tolerated and effective for treating MDR-TB among Chinese patients.

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Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study

PLoS ONE ◽

10.1371/journal.pone.0199320 ◽

2018 ◽

Vol 13 (6) ◽

pp. e0199320 ◽

Cited By ~ 4

Author(s):

Temesgen Yihunie Akalu ◽

Kindie Fentahun Muchie ◽

Kassahun Alemu Gelaye

Keyword(s):

Public Hospitals ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Tuberculosis Patients ◽

Sputum Culture Conversion ◽

Follow Up Study ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Culture Conversion

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Linezolid for the treatment of extensively drug-resistant tuberculosis: a systematic review and meta-analysis

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.18.0822 ◽

2019 ◽

Vol 23 (12) ◽

pp. 1293-1307 ◽

Cited By ~ 1

Author(s):

Z. Lifan ◽

B. Sainan ◽

S. Feng ◽

Z. Siyan ◽

L. Xiaoqing

Keyword(s):

Systematic Review ◽

Initial Dose ◽

Meta Analysis ◽

Treatment Success ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Sputum Culture Conversion ◽

Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Culture Conversion

SETTING: Studies have shown that linezolid (LZD) can be used to treat extensively drug-resistant tuberculosis (XDR-TB).OBJECTIVE: To conduct a systematic review and meta-analysis to assess existing evidence concerning efficacy and safety of LZD for XDR-TB treatment.DESIGN: The MEDLINE@OVID, PubMed, EMBASE, the Cochrane Library, Clinical Trials, Sinomed, CMCI, CNKI, VIP and Wanfang databases were systematically searched for randomised controlled trials, cohort studies, case series or case reports on XDR-TB patients treated with LZD from January 2000 to December 2016. Summary estimates of the rate of sputum culture conversion, treatment success and adverse effects were calculated; data that could not be combined were summarised and described qualitatively. The combined results were examined for heterogeneity, sensitivity and publishing bias.RESULTS: Twenty-two original studies covering a total of 302 patients with XDR-TB fulfilled the inclusion criteria. Pooled estimates for sputum culture conversion and treatment success rates were respectively 93.2% and 67.4% in XDR-TB patients on LZD treatment. The pooled estimates for the rate of myelosuppression, peripheral neuropathy, optic neuritis and adverse reactions of the gastrointestinal tract were respectively 42.5%, 26.0%, 19.0% and 35.0%. Heterogeneity was mostly due to the initial dose of LZD (≤600 mg/d or >600 mg/d), as patients with a high initial dose of LZD were more likely to have myelosuppression (48.4% vs. 24.8%, P = 0.010) and adverse events of the gastrointestinal tract (41.3% vs.15.4%, P = 0.100).CONCLUSION: LZD appears to be effective for XDR-TB, but adverse events are common. An LZD dose of ≤600 mg/d as the initial dose for treating XDR-TB patients is recommended.

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Can Intermittent Dosing Optimize Prolonged Linezolid Treatment of Difficult Multidrug-Resistant Tuberculosis?

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00388-13 ◽

2013 ◽

Vol 57 (7) ◽

pp. 3445-3449 ◽

Cited By ~ 33

Author(s):

Kwok-Chiu Chang ◽

Wing-Wai Yew ◽

Siu-Wai Cheung ◽

Chi-Chiu Leung ◽

Cheuk-Ming Tam ◽

...

Keyword(s):

Multidrug Resistant ◽

Sputum Culture ◽

Drug Resistant ◽

Drug Resistant Tuberculosis ◽

Once Daily ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Extensively Drug Resistant ◽

Culture Conversion

ABSTRACTWe evaluated treatment with linezolid, dosed at 800 mg once daily for 1 to 4 months as guided by sputum culture status and tolerance and then at 1,200 mg thrice weekly until ≥1 year after culture conversion, in addition to individually optimized regimens among 10 consecutive patients with extensively drug-resistant tuberculosis or fluoroquinolone-resistant multidrug-resistant tuberculosis. All achieved stable cure, with anemia corrected and neuropathy stabilized, ameliorated, or avoided after switching to intermittent dosing. Serum linezolid profiles appeared better optimized.

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