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Quantification of multidrug-resistant M. tuberculosis bacilli in sputum during the first 8 weeks of treatment

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SETTING: Mulago Hospital, Kampala, Uganda.

OBJECTIVE: To quantify Mycobacterium tuberculosis in sputum during the first 8 weeks of pulmonary multidrug-resistant TB (MDR-TB) treatment.

DESIGN: We enrolled consecutive adults with pulmonary MDR-TB treated according to national guidelines. We collected overnight sputum samples before treatment and weekly. Sputum samples were cultured on Middlebrook 7H11S agar to measure colony-forming units per mL (cfu/mL) and in MGIT™ 960™ media to measure time to detection (TTD). Linear mixed-effects regression was used to estimate the relational change in log10 cfu/mL and TTD.

RESULTS: Twelve adults (median age: 27 years) were enrolled. Half were women, and two-thirds were HIV-positive. At baseline, median log10 cfu/mL was 5.1, decreasing by 0.29 log10 cfu/mL/week. The median TTD was 116.5 h, increasing in TTD by 36.97 h/week. The weekly change was greater in the first 2 weeks (–1.04 log10 cfu/mL/week and 120.02 h/week) than in the remaining 6 weeks (–0.17 log10 cfu/mL/week and 26.11 h/week).

CONCLUSION: Serial quantitative culture measures indicate a slow, uneven rate of decline in sputum M. tuberculosis over 8 weeks of standardized pulmonary MDR-TB treatment.

Keywords: M. tuberculosis bacilli; anti-TB drug treatment; multidrug-resistant tuberculosis; quantitative cultures; sputum

Document Type: Research Article

Affiliations: 1: Division of Global HIV/AIDS and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA 2: TB or NOT TB Consulting, Little Rock, AR, USA 3: Department of Medical Microbiology and Biomedical Research Center, Makerere University, Kampala, Uganda 4: Uganda-Case Western Research Unit Research Collaboration, Kampala, Uganda

Publication date: November 1, 2022

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