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