Original Research

Predictors of time to sputum culture conversion in multi-drug-resistant tuberculosis and extensively drug-resistant tuberculosis in patients at Tshepong-Klerksdorp Hospital

Relebohile Ncha, Ebrahim Variava, Kennedy Otwombe, Mary Kawonga, Neil A. Martinson
Southern African Journal of Infectious Diseases | Vol 34, No 1 | a111 | DOI: https://doi.org/10.4102/sajid.v34i1.111 | © 2019 Relebohile Ncha, Ebrahim Variava, Kennedy Otwombe, Mary Kawonga, Neil A. Martinson | This work is licensed under CC Attribution 4.0
Submitted: 28 May 2019 | Published: 26 August 2019

About the author(s)

Relebohile Ncha, Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Ebrahim Variava, Department of Internal Medicine, Klerksdorp-Tshepong Hospital Complex and School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and, Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborative Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
Kennedy Otwombe, Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborative Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa
Mary Kawonga, Department of Community Health, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
Neil A. Martinson, Perinatal HIV Research Unit (PHRU), SAMRC Soweto Matlosana Collaborative Centre for HIV/AIDS and TB, University of the Witwatersrand, Johannesburg, South Africa; and, Centre of Excellence in Biomedical TB Research, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

Setting: Klerksdorp-Tshepong Hospital Complex MDR-TB Unit, North-West Province, South Africa.

Background: To determine the time to sputum culture conversion (TTSCC) and factors predictive of TTSCC in patients with multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) in the North-West Province.

Methods: A retrospective cohort study, abstracting patient demographic and clinical data, laboratory results, dates of sputum testing and sputum culture conversion results, from medical records of 526 MDR-TB and 47 XDR-TB patients started on TB treatment between 01 January 2012 and 31 December 2014. Predictors of TTSCC were determined by Cox proportional hazards regression.

Results: The median age was 38 years (interquartile range 31–47) with 64% being male. Overall, 79% (449) were Human Immunodeficiency Virus (HIV)-infected. The median TTSCC was 56.5 days and 162.5 days for MDR-TB and XDR-TB patients, respectively. In the multivariate analysis, age [hazard ratio (HR): 0.89, 95% confidence interval (CI): 0.96–0.99], being underweight (HR: 0.631.61, 95% CI: 0.451.03–0.882.51), Acid Fast Bacilli (AFB) positivity (HR: 0.72, 95% CI: 0.51–1.01) and having XDR-TB (HR: 0.36. 95% CI: 0.19–0.69) were predictive of longer TTSCC.

Conclusion: Predictors of TTSC allow for MDR-TB- and XDR-TB-diagnosed patients to be identified early for effective management. Those with risk factors for delayed sputum culture conversion which are being underweight and having XDR-TB should be monitored carefully during treatment so that they can achieve sputum culture conversion early.


Keywords

Nutrition; Early sputum conversion; Multi-drug-resistant TB; BMI; Predictors; Extensively drug-resistant TB

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