Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study

Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camar; Gladys Djuiga Fotso; Souleymane Camara; Boubacar Bah; Magassouba Aboubacar Sidiki; Alpha Oumar Barry; Thierno Hassane Diallo; Camara Aboubacar; Néné Mamata Bah; Fulgence N’Zabintawali; Souleymane Hassane Haroune; Oumou Younoussa Sow

doi:doi:10.11648/j.cajph.20200601.15

Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, Boubacar Bah, Magassouba Aboubacar Sidiki, Alpha Oumar Barry, Thierno Hassane Diallo, Camara Aboubacar, Néné Mamata Bah, Fulgence N’Zabintawali, Souleymane Hassane Haroune, Oumou Younoussa Sow

Published in Central African Journal of Public Health (Volume 6, Issue 1)

Received: 20 December 2019 Accepted: 4 January 2020 Published: 13 January 2020

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Abstract

Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.

Published in	Central African Journal of Public Health (Volume 6, Issue 1)
DOI	10.11648/j.cajph.20200601.15
Page(s)	23-32
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Conversion, Multidrug-resistant, Tuberculosis, Guinea

References

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[4]	Kurbatova EV, Gammino VM, Bayona J, Becerra MC, Danilovitz M, Falzon D, et al. Predictors of sputum culture conversion among patients treated for multidrug-resistant tuberculosis. Int J Tuberc Lung Dis. 2012; 16 (10): 1335–43.
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[15]	Brust JCM, Lygizos M, Chaiyachati K, Scott M, van der Merwe TL, Moll AP, et al. Culture Conversion Among HIV Co-Infected Multidrug-Resistant Tuberculosis Patients in Tugela Ferry, South Africa. Pai M, editor. PLoS ONE. 2011; 6 (1): e15841.
[16]	Rodriguez M, Monedero I, Caminero JA, Encarnación M, Dominguez Y, Acosta I, et al. Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic. Int J Tuberc Lung Dis. 2013; 17 (4): 520–5.
[17]	Kurbatova EV, Cegielski JP, Lienhardt C, Akksilp R, Bayona J, Becerra MC, et al. Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: a secondary analysis of data from two observational cohort studies. Lancet Respir Med. 2015; 3 (3): 201–9.
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APA Style

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. (2020). Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Central African Journal of Public Health, 6(1), 23-32. https://doi.org/10.11648/j.cajph.20200601.15

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ACS Style

Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camar; Gladys Djuiga Fotso; Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent. Afr. J. Public Health 2020, 6(1), 23-32. doi: 10.11648/j.cajph.20200601.15

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AMA Style

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent Afr J Public Health. 2020;6(1):23-32. doi: 10.11648/j.cajph.20200601.15

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@article{10.11648/j.cajph.20200601.15,
  author = {Boubacar Djelo Diallo and Alhassane Diallo and Lansana Mady Camar and Gladys Djuiga Fotso and Souleymane Camara and Boubacar Bah and Magassouba Aboubacar Sidiki and Alpha Oumar Barry and Thierno Hassane Diallo and Camara Aboubacar and Néné Mamata Bah and Fulgence N’Zabintawali and Souleymane Hassane Haroune and Oumou Younoussa Sow},
  title = {Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study},
  journal = {Central African Journal of Public Health},
  volume = {6},
  number = {1},
  pages = {23-32},
  doi = {10.11648/j.cajph.20200601.15},
  url = {https://doi.org/10.11648/j.cajph.20200601.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20200601.15},
  abstract = {Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.},
 year = {2020}
}

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TY  - JOUR
T1  - Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study
AU  - Boubacar Djelo Diallo
AU  - Alhassane Diallo
AU  - Lansana Mady Camar
AU  - Gladys Djuiga Fotso
AU  - Souleymane Camara
AU  - Boubacar Bah
AU  - Magassouba Aboubacar Sidiki
AU  - Alpha Oumar Barry
AU  - Thierno Hassane Diallo
AU  - Camara Aboubacar
AU  - Néné Mamata Bah
AU  - Fulgence N’Zabintawali
AU  - Souleymane Hassane Haroune
AU  - Oumou Younoussa Sow
Y1  - 2020/01/13
PY  - 2020
N1  - https://doi.org/10.11648/j.cajph.20200601.15
DO  - 10.11648/j.cajph.20200601.15
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 23
EP  - 32
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20200601.15
AB  - Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.
VL  - 6
IS  - 1
ER  -

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Author Information

Boubacar Djelo Diallo

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Alhassane Diallo

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Lansana Mady Camar

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Gladys Djuiga Fotso

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Souleymane Camara

National Tuberculosis Control Program, Conakry, Guinea
Boubacar Bah

Carrière Tuberculosis Center, Conakry, Guinea
Magassouba Aboubacar Sidiki

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Alpha Oumar Barry

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Thierno Hassane Diallo

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Camara Aboubacar

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
Néné Mamata Bah

National Reference Laboratory for Mycobacteria, Conakry, Guinea
Fulgence N’Zabintawali

National Reference Laboratory for Mycobacteria, Conakry, Guinea
Souleymane Hassane Haroune

Action Damien, Conakry, Guinea
Oumou Younoussa Sow

Department of Pneumo-Phtisiology, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea

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APA Style

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. (2020). Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Central African Journal of Public Health, 6(1), 23-32. https://doi.org/10.11648/j.cajph.20200601.15

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ACS Style

Boubacar Djelo Diallo; Alhassane Diallo; Lansana Mady Camar; Gladys Djuiga Fotso; Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent. Afr. J. Public Health 2020, 6(1), 23-32. doi: 10.11648/j.cajph.20200601.15

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AMA Style

Boubacar Djelo Diallo, Alhassane Diallo, Lansana Mady Camar, Gladys Djuiga Fotso, Souleymane Camara, et al. Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study. Cent Afr J Public Health. 2020;6(1):23-32. doi: 10.11648/j.cajph.20200601.15

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@article{10.11648/j.cajph.20200601.15,
  author = {Boubacar Djelo Diallo and Alhassane Diallo and Lansana Mady Camar and Gladys Djuiga Fotso and Souleymane Camara and Boubacar Bah and Magassouba Aboubacar Sidiki and Alpha Oumar Barry and Thierno Hassane Diallo and Camara Aboubacar and Néné Mamata Bah and Fulgence N’Zabintawali and Souleymane Hassane Haroune and Oumou Younoussa Sow},
  title = {Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study},
  journal = {Central African Journal of Public Health},
  volume = {6},
  number = {1},
  pages = {23-32},
  doi = {10.11648/j.cajph.20200601.15},
  url = {https://doi.org/10.11648/j.cajph.20200601.15},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cajph.20200601.15},
  abstract = {Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.},
 year = {2020}
}

Copy | Download

TY  - JOUR
T1  - Risk Score to Predict Time-to Sputum Smear and Culture Conversions in Patients Treated with Shorter MDR Tuberculosis Regime in Guinea: A Retrospective Cohort Study
AU  - Boubacar Djelo Diallo
AU  - Alhassane Diallo
AU  - Lansana Mady Camar
AU  - Gladys Djuiga Fotso
AU  - Souleymane Camara
AU  - Boubacar Bah
AU  - Magassouba Aboubacar Sidiki
AU  - Alpha Oumar Barry
AU  - Thierno Hassane Diallo
AU  - Camara Aboubacar
AU  - Néné Mamata Bah
AU  - Fulgence N’Zabintawali
AU  - Souleymane Hassane Haroune
AU  - Oumou Younoussa Sow
Y1  - 2020/01/13
PY  - 2020
N1  - https://doi.org/10.11648/j.cajph.20200601.15
DO  - 10.11648/j.cajph.20200601.15
T2  - Central African Journal of Public Health
JF  - Central African Journal of Public Health
JO  - Central African Journal of Public Health
SP  - 23
EP  - 32
PB  - Science Publishing Group
SN  - 2575-5781
UR  - https://doi.org/10.11648/j.cajph.20200601.15
AB  - Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (<3 +) of initial culture (aHR=1.52, 1.09–2.14) and previously history of TB treatment (aHR=2.10, 1.26–3.51) were more likely to have culture conversion, while only the higher BMI (aHR=1.10, 1.03–1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855±0.023 and 0.883±0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months. Conclusion: The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime.
VL  - 6
IS  - 1
ER  -

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