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Multicenter Study
. 2018 Jun 21;13(6):e0199320.
doi: 10.1371/journal.pone.0199320. eCollection 2018.

Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study

Temesgen Yihunie Akalu  1 , Kindie Fentahun Muchie  1 , Kassahun Alemu Gelaye  1
Affiliations
Multicenter Study

Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study

Temesgen Yihunie Akalu et al. PLoS One. .

Abstract

Background: In Ethiopia, Multi-drug resistant Tuberculosis (MDR-TB) is one of the major public health problems that need great attention. Time to sputum culture conversion is often used as an early predictive value for the final treatment outcome. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Ethiopia. This study was aimed at determining the time to sputum culture conversion and the determinants among MDR-TB patients at public Hospitals of the Amhara Regional State.

Methods: A retrospective follow up study was conducted between September 2010 and December 2016. Three hundred ninety two MDR-TB patients were included in the study. Parametric frailty models were fitted and Cox Snell residual was used for goodness of fit, which the Akaike's information criteria was used for model selection. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of association.

Result: Out of the 392 participants, sputum culture changed for 340(86.7%) during the follow up period. The median culture conversion time in this study was 65 (60-70 days). Alcohol drinking (AHR = 3.79, 95%CI = 1.65-8.68), sputum smear grading +2 (AHR = 0.39, 95%CI 0.19-0.79), smear grading +3 (AHR = 0.30, CI = 0.14-064), cavitations (AHR = 0.36, 95%CI = 0.19-0.68), and consolidation (AHR = 0.29, CI = 0.13-0.69) were the determinants of time to sputum culture conversion.

Conclusion: In this study, time to sputum culture was rapid as compared to 4 months WHO recommendation. Alcohol drinking, sputum smear grading, cavitations and consolidations were found to be the determinants of time to sputum culture conversion. Therefore, providing a special attention to patients who had baseline radiological finding is recommended, high bacillary load and patients with a history of alcohol intake at baseline should be given priority.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overall treatment outcome of MDR-TB patients at public hospitals in the Amhara Regional State, September 2010 to December 2016.
Fig 2
Fig 2. Kaplan-Meier survival curve of MDR-TB patients on initial culture conversion at public hospitals in the Amhara Regional State, September 2010 to December 2016.
Differences in all variables at baseline between strata were determined using the log rank (χ2) test, and the equality of hazard was assessed for the different explanatory variables. According to the test results, the presence of infiltration p-value = 0.00, cavitations p-value = 0.00, consolidation p-value = 0.01, Fibrotic change p-value = 0.00, functional status p-value = 0.03, sputum smear grading p-value = 0.00 and resistance type p-value = 0.00associated with initial culture conversion time at 5% level of significance.
Fig 3
Fig 3. Kaplan-Meier curve of surviving MDR-TB patients on initial culture conversion by baseline functional status at public hospitals in the Amhara Regional State, Ethiopia, September 2010 to December 2016.
Fig 4
Fig 4. Plot of the probability of survival by hospital and the time of follow up (in days) among MDR-TB patients at public hospitals in the Amhara Regional State, September 2010 to December 2016.
Fig 5
Fig 5. Goodness of fit test for univariate Weibull distribution gamma frailty model.
See this image and copyright information in PMC

References

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