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. 2022 Nov 1;26(11):1058-1064.
doi: 10.5588/ijtld.21.0741.

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

S E Smith-Jeffcoat  1 , K D Eisenach  2 , M Joloba  3 , W Ssengooba  3 , C Namaganda  3 , M Nsereko  4 , B Okware  4 , J S Cavanaugh  1 , J P Cegielski  1
Affiliations

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

S E Smith-Jeffcoat et al. Int J Tuberc Lung Dis. .

Abstract
in English, French

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.

CONTEXTE:: Hôpital de Mulago, Kampala, Ouganda.

OBJECTIF:: Quantifier Mycobacterium tuberculosis dans les échantillons de crachats pendant les huit premières semaines du traitement de la TB pulmonaire multirésistante (MDR-TB).

MÉTHODE:: Nous avons inclus, de manière consécutive, des adultes atteints de MDR-TB pulmonaire traités conformément aux recommandations nationales. Nous avons recueilli les échantillons de crachats nocturnes avant l’instauration du traitement, ainsi qu’une fois par semaine. Les échantillons de crachats ont été mis en culture sur gélose Middlebrook 7H11S afin de mesurer les unités formant colonies par mL (cfu/mL) et en milieu MGIT™ 960™ pour mesurer le temps avant détection (TTD). Une régression linéaire à effets mixtes a été utilisée afin d’estimer le changement relatif en log10 cfu/mL et TTD.

RÉSULTATS:: Douze adultes (âge médian : 27 ans) ont été inclus. La moitié était des femmes et les deux tiers étaient infectés par le VIH. Lors de l’inclusion, la valeur log10 cfu/mL médiane était de 5,1, diminuant à 0,29 log10 cfu/mL/semaine. Le TTD médian était de 116,5 h, avec une augmentation du TTD de 36,97 h/semaine. Le changement hebdomadaire était plus important au cours des deux premières semaines (−1,04 log10 cfu/mL/semaine et 120,02 heures/semaine) qu’au cours des six semaines restantes (−0,17 log10 cfu/mL/semaine et 26,11 heures/semaine).

CONCLUSION:: Les mesures quantitatives en série des cultures indiquent un taux de décroissance faible et irrégulier de M. tuberculosis dans les échantillons de crachats au cours de 8 semaines d’un traitement standardisé de la MDR-TB pulmonaire.

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Figures

Figure 1
Figure 1
Median log10 cfu/mL of participants (n = 12) during the first 8 weeks of multidrug-resistant TB treatment in Kampala, Uganda. The number of unquantifiable data points at each week are represented below the limit of detection (dotted line). The number in parentheses represents the number of M. tuberculosis-negative cultures. The remaining were contaminated. cfu = colony forming units.
Figure 2
Figure 2
Change in log10 cfu/mL during the first 8 weeks of multidrug-resistant TB treatment per participant ordered by date of enrollment in Kampala, Uganda. cfu = colony forming units.
Figure 3
Figure 3
TTD in hours of participants (n = 11) during the first 8 weeks of multidrug-resistant TB treatment. The number of unquantifiable data points at each week are represented just above the limit of detection (dotted line). The number in parentheses represents the number of M. tuberculosis-negative cultures. The remaining were contaminated. TTD = time to detection.
Figure 4
Figure 4
Change in TTD of M. tuberculosis during the first 8 weeks of multidrug-resistant TB treatment per participant ordered by date of enrollment. Unfilled circles represent negative culture results. TTD = time to detection.
See this image and copyright information in PMC

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