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

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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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Keywords: MDR-TB; culture conversion; performance; prognostic marker; treatment outcomes

Document Type: Research Article

Affiliations: 1: Epicentre, Paris, France 2: National Tuberculosis Control Office, Yerevan, Armenia 3: Programmatic Management of Drug-resistant Tuberculosis, Ministry of Health, Nairobi, Kenya 4: National Tuberculosis Program, Tbilisi, Georgia 5: Ministry of Health-TB National Control Program National Manager, Mbabane, Swaziland 6: Respiratory Disease Department, National Public Health Institute, Bogota, Colombia 7: Médecins Sans Frontières, Geneva, Switzerland 8: Médecins Sans Frontières, Paris 9: Epicentre, Paris, France, Unité Mixte Internationale UMI233-U1175, Institute of Research for Development, Montpellier, France

Publication date: October 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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