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Free Content Cigarette smoking and culture conversion in patients with susceptible and M/XDR-TB

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BACKGROUND: Tuberculosis (TB) is a leading cause of morbidity and mortality worldwide. Active cigarette smoking may have a significant impact on treatment responses to anti-tuberculosis treatment.

OBJECTIVE: To ascertain the effect of smoking on Mycobacterium tuberculosis sputum culture conversion rates following treatment initiation in patients with susceptible, multidrug-resistant and extensively drug-resistant TB (M/XDR-TB).

METHOD: Sputum cultures of smoking and non-smoking patients with pulmonary TB (PTB) treated at a referral centre in Germany were evaluated.

RESULTS: Between January 2012 and March 2017, 247 patients with PTB treated at the Medical Clinic of Research Center Borstel, Borstel, Germany, were included in the study. Of 247 patients, 65 (26.3%) were infected with multidrug-resistant strains of M. tuberculosis (MDR-TB). Sputum culture examinations were performed on a weekly basis. Active smoking (n = 111; time to culture conversion [TCC] 50.7 days, interquartile range [IQR] 26.5–73.0) and former smoking (n = 72; TCC 43.1 days, IQR 19.8–56.0) significantly delayed culture conversion rates (P < 0.001) when compared with never smoking (n = 64; TCC 33.2 days, IQR 8.0–50.3). Delay in TCC among smoking, non-MDR-TB patients (n = 138; TCC 47.3 days, IQR 19.0–89.0) was comparable with non-smoking, MDR-TB patients (n = 20; TCC 53.0 days, IQR 18.0–71.0). The shortest TCC was observed in non-smoking, non-MDR-TB patients (n = 44; TCC 33.0 days, IQR 10.0–48.5), whereas the longest was seen in smoking, MDR-TB patients (n = 45; TCC 60.7 days, IQR 33.3–89.0); P < 0.001).

CONCLUSION: Active cigarette smoking and, to a lesser extent, former cigarette smoking, substantially delayed culture conversion in PTB.
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Keywords: MDR-TB; culture conversion; smoking, tuberculosis; treatment response

Document Type: Research Article

Affiliations: 1: Division of Clinical Infectious Diseases, Research Centre Borstel, Borstel, German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany 2: Division of Clinical Infectious Diseases, Research Centre Borstel, Borstel, German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany 3: Department of Pulmonary Medicine, Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital, Linz, Austria 4: Division of Clinical Infectious Diseases, Research Centre Borstel, Borstel, German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel, International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany, Department of Medicine, Karolinska Institute, Stockholm, Sweden

Publication date: January 1, 2019

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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