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Journal Article > Research

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

Bastard M, Sanchez-Padilla E, Hayrapetyan A, Kimenye K, Khurkhumal S, Dlamini T, Fadul Perez S, Telnov A, Hewison CCH, Varaine FFV, Bonnet MMB
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Abstract
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.
Countries
ArmeniaColombiaGeorgiaKyrgyzstan
Subject Area
tuberculosisantimicrobial resistance
DOI
10.5588/ijtld.18.0649
Published Date
01-Oct-2019
PubMed ID
31627770
Languages
English
Journal
International Journal of Tuberculosis and Lung Disease
Volume / Issue / Pages
Volume 23, Issue 10, Pages 1060-1067(8)
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