What is the best culture conversion prognostic marker for patients treated for multidrug-resistant tuberculosis?

INTRODUCTION: Identification of good prognostic marker for tuberculosis (TB) treatment response is a necessary step on the path towards a surrogate marker to reduce TB trial duration.METHODS: We performed a retrospective analysis on routinely collected data in 6 drug-resistant TB (DRTB) programs. Culture conversion, defined as two consecutive negative cultures, was assessed, and performance of culture conversion at Month 2 and Month 6 to predict treatment success were explored. To explore factors associated with positive predicted value (PPV) and the specificity of culture conversion, a multinomial logistic regression was fitted.RESULTS: This study included 634 patients: 68.5% were males; the median age was 35 years, 75.2% were previously treated for TB, 59.4% were resistant only to isoniazid and rifampicin and 18.1% resistant to fluoroquinolones. Culture conversion at Month 2 and 6 showed similar PPV while specificity was much higher for culture conversion at Month 2: 91.3% (95%CI 86.1–95.1). PPV of culture conversion at Month 2 did not vary strongly according to patients' characteristics, while specificity was slightly higher among patients with fluoroquinolone-resistant strains.CONCLUSION: Culture conversion at Month 2 is an acceptable prognostic marker for MDR-TB treatment. Considering the advantage of using an earlier marker, further evaluation as a surrogate marker is warranted to shorten TB trials.

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Treatment success using novel and adapted treatment regimens in registered DR-TB children in Dushanbe, Tajikistan, 2013-2019

The Journal of Infection in Developing Countries ◽

10.3855/jidc.14798 ◽

2021 ◽

Vol 15 (09.1) ◽

pp. 7S-16S

Author(s):

Bobojon Pirmahmadzoda ◽

Katrina Hann ◽

Kristina Akopyan ◽

Ruzanna Grigoryan ◽

Evgenia Geliukh ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Short Treatment ◽

Female Ratio ◽

Treatment Regimens ◽

Tb Treatment ◽

National Tuberculosis ◽

Mdr Tb ◽

Pediatric Tb ◽

Culture Conversion

Introduction: Approximately 3% of all pediatric TB cases develop MDR-TB, with only 3–4% of such children receiving MDR-TB treatment. In Tajikistan, children as a proportion of all DR-TB in the country increased from 4.3 to 7.5% during 2013-2018. Despite limited evidence on the use of new anti-TB drugs in children, WHO has updated its guidelines for DR-TB treatment for children, and Tajikistan did so in 2013 and 2017. Novel and adapted regimens included individual regimens for RR/MDR, XDR (with and without Bedaquiline and Delamanid) and short treatment regimens with and without injectables. It is important to document the outcomes of the treatment regimens. Therefore, the aim of this study was to describe characteristics of children receiving different treatment regimens for DR-TB, the culture conversion and treatment outcomes. Methodology: Cohort study of children enrolled in DR-TB treatment by the National Tuberculosis Program in Dushanbe, Tajikistan, January 2013 to July 2019. Results: The study included 60 DR-TB children. The male to female ratio was 1:2 and mean age 13.6 years. Median time to culture conversion was 66 days [IQR:31-103; Range:2-232]. In children with treatment outcomes (N = 58), 93% had favorable outcomes. There were four children (7%) with unfavorable treatment outcomes, all of whom were female 15-17 years, on standard (RR/MDR) treatment during 2013-2015. Favorable outcomes by DR-TB type were 91%, 90%, and 100% in RR/MDR, PreXDR, and XDR-TB patients, respectively. Conclusions: All children enrolled after the introduction of modified guidelines for novel and adapted regimens for DR-TB showed positive TB treatment outcomes.

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Effectiveness of Shorter Treatment Regimen in Multidrug-Resistant Tuberculosis Patients in Pakistan: A Multicenter Retrospective Record Review

American Journal of Tropical Medicine and Hygiene ◽

10.4269/ajtmh.20-1134 ◽

2021 ◽

Author(s):

Abudl Wahid ◽

Nafees Ahmad ◽

Abdul Ghafoor ◽

Abdullah Latif ◽

Fahad Saleem ◽

...

Keyword(s):

Treatment Failure ◽

Success Rate ◽

Treatment Success ◽

Multidrug Resistant ◽

Retrospective Record Review ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

Record Review

In Pakistan, the treatment of multidrug-resistant tuberculosis (MDR-TB) with a shorter treatment regimen (STR), that is, 4–6 months of amikacin, moxifloxacin (Mfx), ethionamide, clofazimine (Cfz), pyrazinamide (Z), ethambutol (E), and high-dose isoniazid, followed by 5 months of Mfx, Cfz, Z, and E, was initiated in 2018. However, there is a lack of information about its effectiveness in Pakistani healthcare settings. Therefore, this retrospective record review of MDR-TB patients treated with STR at eight treatment sites in Pakistan aimed to fill this gap. Data were analyzed using SPSS 23. Multivariate binary logistic regression (MVBLR) analysis was conducted to find factors associated with death and treatment failure, and lost to follow-up (LTFU). A P-value < 0.05 was considered statistically significant. Of 912 MDR-TB patients enrolled at the study sites, only 313 (34.3%) eligible patients were treated with STR and included in the current study. Of them, a total of 250 (79.9%) were cured, 12 (3.8%) completed treated, 31 (9.9%) died, 16 (5.1%) were LTFU, and four (1.3%) were declared as treatment failures. The overall treatment success rate was 83.7%. In MVBLR analysis, patients’ age of 41–60 (odds ratio [OR] = 4.9, P-value = 0.020) and > 60 years (OR = 3.6, P-value = 0.035), being underweight (OR = 2.7, P-value = 0.042), and previous TB treatment (OR = 0.4, P-value = 0.042) had statistically significant association with death and treatment failure, whereas patients’ age of > 60 years (OR = 5.4, P-value = 0.040) and previous TB treatment (OR = 0.2, P-value = 0.008) had statistically significant association with LTFU. The treatment success rate of STR was encouraging. However, to further improve the treatment outcomes, special attention should be paid to the patients with identified risk factors.

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Polymorphisms in the vitamin D receptor gene are associated with reduced rate of sputum culture conversion in multidrug-resistant tuberculosis patients in South Africa

10.1101/132852 ◽

2017 ◽

Author(s):

Matthew J Magee ◽

Yan V. Sun ◽

James CM Brust ◽

N. Sarita Shah ◽

Yuming Ning ◽

...

Keyword(s):

South Africa ◽

Vitamin D ◽

Multidrug Resistant ◽

Sputum Culture ◽

Vdr Gene ◽

Sputum Culture Conversion ◽

Tb Treatment ◽

Genomic Analyses ◽

Mdr Tb ◽

Culture Conversion

AbstractBackgroundVitamin D modulates the inflammatory and immune response to tuberculosis (TB) and also mediates the induction of the antimicrobial peptide cathelicidin. Deficiency of 25-hydroxyvitamin D and single nucleotide polymorphisms (SNPs) in the vitamin D receptor (VDR) gene may increase the risk of TB disease and decrease culture conversion rates in drug susceptible TB. Whether these VDR SNPs are found in African populations or impact multidrug-resistant (MDR) TB treatment has not been established. We aimed to determine if SNPs in the VDR gene were associated with sputum culture conversion among a cohort of MDR TB patients in South Africa.MethodsWe conducted a prospective cohort study of adult MDR TB patients receiving second-line TB treatment in KwaZulu-Natal province. Subjects had monthly sputum cultures performed. In a subset of participants, whole blood samples were obtained for genomic analyses. Genomic DNA was extracted and genotyped with Affymetrix Axiom Pan-African Array. Cox proportional models were used to determine the association between VDR SNPs and rate of culture conversion.ResultsGenomic analyses were performed on 91 MDR TB subjects enrolled in the sub-study; 60% were female and median age was 35 years (interquartile range [IQR] 29-42). Smoking was reported by 21% of subjects and most subjects had HIV (80%), were smear negative (57%), and had cavitary disease (55%). Overall, 87 (96%) subjects initially converted cultures to negative, with median time to culture conversion of 57 days (IQR 17-114). Of 121 VDR SNPs examined, 10 were significantly associated (p<0.01) with rate of sputum conversion in multivariable analyses. Each additional risk allele on SNP rs74085240 delayed culture conversion significantly (adjusted hazard ratio 0.30, 95% confidence interval 0.14-0.67).ConclusionsPolymorphisms in the VDR gene were associated with rate of sputum culture conversion in MDR TB patients in this high HIV prevalence setting in South Africa.Author contributionsMJM, YVS, JCMB, SS, and NRG conceived and designed the study and drafted the initial manuscript. MJM, YVS, YN, and QH performed the data analyses. All authors contributed to interpretation of the data, revised the manuscript, and approved the final version.The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention (CDC). The use of trade names and commercial sources is for identification only and does not imply endorsement by the CDC.

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Effectiveness and Safety of Bedaquiline-containing Regimens for Treatment on Patients With Refractory Rifampicin/multidrug-resistant Tuberculosis: A Retrospective Cohort Study in East China

10.21203/rs.3.rs-833736/v1 ◽

2021 ◽

Author(s):

Shao-Jun Zhang ◽

Yan Yang ◽

Wen-Wen Sun ◽

Zhong-Shun Zhang ◽

He-ping Xiao ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Multidrug Resistant ◽

East China ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Conversion Rates ◽

Mdr Tb ◽

Culture Conversion ◽

Closing Rate

Abstract Objective: To compare the effectiveness and safety of bedaquiline-containing and bedaquiline-free regimens for treatment of patients with refractory rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB).Methods: Patients with refractory RR/MDR-TB receiving bedaquiline-containing regimens (bedaquiline group, n=102) and bedaquiline-free regimens (non-bedaquiline group, n=100) were included in this retrospective historical control study across East China. The culture conversion, end-of-treatment outcomes, cavity closing rate, and adverse events (AEs) were compared between the two groups. Univariate and multivariate analyses were performed to identify independent predictors of treatment success and culture reversion.Results: The baseline characteristics of the patients were well balanced between the two groups. The culture conversion rates in the bedaquiline group at month 3 (89.2% vs. 66.0%), month 6 (90.2% vs. 72.0%), month 9 (91.2% vs. 66.0%), and month 12 (94.1% vs. 65.0%) were all significantly higher than those in the non-bedaquiline group (all p<0.001). Similar results were observed in the cavity closing rate at month 9 (19.6% vs. 8.0%, p=0.017) and month 12 (39.2% vs. 15.0%, p<0.001). Patients receiving bedaquiline-containing regimens had more treatment success than those receiving bedaquiline-free regimens (p<0.001; cure rate, 69.6% vs. 45.0%; complete the treatment, 22.5% vs. 18.0%; treatment success, 92.2% vs. 63.0%). The use of bedaquiline was identified as an independent predictor of both treatment success (OR=7.356, 95% CI: 2.920–18.530, p<0.001) and culture reversion (OR=0.124, 95% CI: 0.035–0.452, p<0.001). AEs were similarly reported in 26.5% of patients in the bedaquiline group and 19.0% in the non-bedaquiline group (p=0.206).Conclusions: Bedaquiline-containing regimens resulted in better treatment outcomes and similar safety relative to bedaquiline-free regimens for patients with refractory pulmonary RR/MDR-TB.

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Determination of MIC Breakpoints for Second-Line Drugs Associated with Clinical Outcomes in Multidrug-Resistant Tuberculosis Treatment in China

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.03008-15 ◽

2016 ◽

Vol 60 (8) ◽

pp. 4786-4792 ◽

Cited By ~ 14

Author(s):

Xubin Zheng ◽

Rongrong Zheng ◽

Yi Hu ◽

Jim Werngren ◽

Lina Davies Forsman ◽

...

Keyword(s):

Treatment Outcome ◽

Treatment Success ◽

Multidrug Resistant ◽

Classification And Regression Tree ◽

Second Line ◽

Cart Analysis ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

ABSTRACTOur study aims to identify the clinical breakpoints (CBPs) of second-line drugs (SLDs) above which standard therapy fails in order to improve multidrug-resistant tuberculosis (MDR-TB) treatment. MICs of SLDs were determined forM. tuberculosisisolates cultured from 207 MDR-TB patients in a prospective cohort study in China between January 2010 and December 2012. Classification and regression tree (CART) analysis was used to identify the CBPs predictive of treatment outcome. Of the 207 MDR-TB isolates included in the present study, the proportion of isolates above the critical concentration recommended by WHO ranged from 5.3% in pyrazinamide to 62.8% in amikacin. By selecting pyrazinamide as the primary node (CBP, 18.75 mg/liter), 72.1% of sputum culture conversions at month four could be predicted. As for treatment outcome, pyrazinamide (CBP, 37.5 mg/liter) was selected as the primary node to predict 89% of the treatment success, followed by ofloxacin (CBP, 3 mg/liter), improving the predictive capacity of the primary node by 10.6%. Adjusted by identified confounders, the CART-derived pyrazinamide CBP remained the strongest predictor in the model of treatment outcome. Our findings indicate that the critical breakpoints of some second-line drugs and PZA need to be reconsidered in order to better indicate MDR-TB treatment outcome.

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Analysis of treatment outcome in multi-drug resistant tuberculosis patients treated under programmatic conditions

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172122 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2401 ◽

Cited By ~ 2

Author(s):

A. K. Janmeja ◽

Deepak Aggarwal ◽

Ruchika Dhillon

Keyword(s):

Treatment Outcome ◽

Success Rate ◽

Treatment Adherence ◽

Treatment Success ◽

Treatment Practice ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multi Drug Resistant Tuberculosis ◽

Mdr Tb ◽

Culture Conversion

Background: Programmatic management of MDR-TB has taken over the un-standardized and unsupervised treatment practice in India. However, despite being implemented in whole of country, the data on the program surveillance is scarce. Hence the present study was sought to evaluate the treatment outcome in patients with MDR TB in Chandigarh being treated under programmatic conditions.Methods: A retrospective study was carried out by enrolling all MDR-TB patients registered between January 2012 to December 2014. Medical records of 140 patients were scrutinized for necessary information on demographic, clinical parameters and previous TB treatment. Treatment outcomes to Cat IV anti-TB therapy, any interruptions in treatment, adverse drug reactions, culture conversion etc. were evaluated from the records.Results: Of the 140 patients, 77 (55%) were declared cured, 11 (7.9%) completed treatment, 23 patients (16.4%) died, 13 (9.3%) defaulted on treatment, 5 (3.6%) had treatment failure and 11 (7.9%) were shifted to Cat V therapy. On comparison, BMI, haemoglobin, treatment outcome in previous ATT, treatment adherence and time to sputum culture conversion were significantly different in different treatment outcome groups.Conclusions: The treatment success rate of MDR‑TB patients have shown improvement under programmatic conditions. Interventions to improve BMI and treatment adherence might further help to improve the success rate.

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Molecular Evaluation of Fluoroquinolone Resistance in Serial Mycobacterium tuberculosis Isolates from Individuals Diagnosed with Multidrug-Resistant Tuberculosis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01663-20 ◽

2020 ◽

Vol 65 (1) ◽

pp. e01663-20

Author(s):

Melisa Willby ◽

Paige Chopra ◽

Darrin Lemmer ◽

Katherine Klein ◽

Tracy L. Dalton ◽

...

Keyword(s):

Treatment Success ◽

Multidrug Resistant ◽

Fluoroquinolone Resistance ◽

Personal Genome ◽

Genotypic Resistance ◽

Phenotypic Resistance ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb

ABSTRACTFluoroquinolones (FQ) are crucial components of multidrug-resistant tuberculosis (MDR TB) treatment. Differing levels of resistance are associated with specific mutations within the quinolone-resistance-determining region (QRDR) of gyrA. We sequenced the QRDR from serial isolates of MDR TB patients in the Preserving Effective TB Treatment Study (PETTS) with baseline FQ resistance (FQR) or acquired FQ resistance (FQACQR) using an Ion Torrent Personal Genome Machine (PGM) to a depth of 10,000× and reported single nucleotide polymorphisms in ≥1% of reads. FQR isolates harbored 15 distinct alleles with 1.3 (maximum = 6) on average per isolate. Eighteen alleles were identified in FQACQR isolates with an average of 1.6 (maximum = 9) per isolate. Isolates from 78% of FQACQR individuals had mutant alleles identified within 6 months of treatment initiation. Asp94Gly was the predominant allele in the initial FQ-resistant isolates followed by Ala90Val. Seventy-seven percent (36/47) of FQACQR group patients had isolates with FQ resistance alleles prior to changes to the FQ component of their treatment. Unlike the individuals treated initially with other FQs, none of the 21 individuals treated initially with levofloxacin developed genotypic or phenotypic FQ resistance, although country of residence was likely a contributing factor since 69% of these individuals were from a single country. Initial detection of phenotypic resistance and genotypic resistance occurred simultaneously for most; however, phenotypic resistance occurred earlier in isolates harboring mixtures of alleles of very low abundance (<1% of reads), whereas genotypic resistance often occurred earlier for alleles associated with low-level resistance. Understanding factors influencing acquisition and evolution of FQ resistance could reveal strategies for improved treatment success.

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Predicting the Outcomes of New Short-Course Regimens for Multidrug-Resistant Tuberculosis Using Intrahost and Pharmacokinetic-Pharmacodynamic Modeling

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01487-18 ◽

2018 ◽

Vol 62 (12) ◽

Cited By ~ 2

Author(s):

Tan N. Doan ◽

Pengxing Cao ◽

Theophilus I. Emeto ◽

James M. McCaw ◽

Emma S. McBryde

Keyword(s):

Treatment Duration ◽

Treatment Success ◽

Empirical Evaluation ◽

Multidrug Resistant ◽

Pharmacodynamic Modeling ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Short Course ◽

Mdr Tb

ABSTRACT Short-course regimens for multidrug-resistant tuberculosis (MDR-TB) are urgently needed. Limited data suggest that the new drug bedaquiline (BDQ) may have the potential to shorten MDR-TB treatment to less than 6 months when used in conjunction with standard anti-TB drugs. However, the feasibility of BDQ in shortening MDR-TB treatment duration remains to be established. Mathematical modeling provides a platform to investigate different treatment regimens and predict their efficacy. We developed a mathematical model to capture the immune response to TB inside a human host environment. This model was then combined with a pharmacokinetic-pharmacodynamic model to simulate various short-course BDQ-containing regimens. Our modeling suggests that BDQ could reduce MDR-TB treatment duration to just 18 weeks (4 months) while still maintaining a very high treatment success rate (100% for daily BDQ for 2 weeks, or 95% for daily BDQ for 1 week during the intensive phase). The estimated time to bacterial clearance of these regimens ranges from 27 to 33 days. Our findings provide the justification for empirical evaluation of short-course BDQ-containing regimens. If short-course BDQ-containing regimens are found to improve outcomes, then we anticipate clear cost savings and a subsequent improvement in the efficiency of national TB programs.

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Ambulatory Treatment for Multidrug-Resistant Tuberculosis in Rural Haiti: A Mixed-Methods Study of Social and Economic Factors Affecting Timely Diagnosis and Treatment Success

Global Journal of Health Science ◽

10.5539/gjhs.v13n7p99 ◽

2021 ◽

Vol 13 (7) ◽

pp. 99

Author(s):

Jude Beauchamp ◽

Carole D. Mitnick ◽

Hannah Gilbert ◽

Fernet Leandre ◽

Yoldine Talina Jean Noel ◽

...

Keyword(s):

Mixed Methods ◽

Quantitative Assessment ◽

Treatment Initiation ◽

Treatment Success ◽

Poor Response ◽

Multidrug Resistant ◽

Mixed Methods Study ◽

Ambulatory Treatment ◽

Tb Treatment ◽

Mdr Tb

BACKGROUND AND OBJECTIVES: Patients with MDR-TB in remote areas of Haiti face barriers that delay their ability to initiate and complete treatment. These barriers must be addressed to ensure successful decentralization of MDR-TB treatment. We conducted a mixed-methods study at two MDR-TB facilities in rural Haiti to identify factors that impact MDR-TB treatment initiation and documented treatment response after discharge from hospital. METHODS: We enrolled patients who started MDR-TB treatment at two Zanmi Lasante MDR-TB facilities in Haiti between October 2015 and March 2016. We conducted interviews with patients at discharge to assess factors creating delay in treatment initiation; performed a longitudinal quantitative assessment of patient wellbeing at discharge and for four months after; and conducted a second interview with the same patients and family caregivers to identify obstacles to transition from hospital-based care to ambulatory treatment. Qualitative data were coded into six final conceptual categories representing patient experiences with TB treatment and care. We then explored how the patient experience during transition might affect the score obtained in the quantitative assessment. RESULTS: We enrolled 17 MDR-TB patients and 16 family members. Four patients were identified as having poor clinical response after discharge, characterized by low BMI, low hemoglobin, compromised activities of daily life, food insecurity, depression and other treatment side effects. Patients with poor response also experienced limited social support and difficult living conditions. Factors contributing to delayed treatment initiation were present at discharge and may compromise response. These include financial (lost wages, costly transportation) and logistical barriers to reaching highly centralized treatment facilities. The results highlight the barriers that MDR-TB patients in rural Haiti face to find and successfully complete lifesaving treatment. CONCLUSION: Properly implemented decentralized care will help overcome geographical barriers. Strong nutritional, social and financial support are essential to support appropriate treatment for the disease.

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Risk score to predict time-to sputum smear and culture conversions in patients treated with shorter MDR-tuberculosis regime in Guinea (Conakry): A retrospective cohort study.

10.21203/rs.2.14492/v1 ◽

2019 ◽

Author(s):

Alhassane Diallo ◽

Boubacar Djelo Diallo ◽

Lansana Mady Camara ◽

Gladys Djuiga Fotso ◽

Souleymane Camara ◽

...

Keyword(s):

Risk Score ◽

Multidrug Resistant ◽

Optimal Time ◽

Sputum Smear ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Positive Smear ◽

Mdr Tb ◽

Initial Culture ◽

Culture Conversion

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 scoreMethods 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. Keywords: Conversion, Multidrug-resistant, Tuberculosis, Guinea.

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