Factors associated with sputum culture conversion in patients with multidrug-resistant tuberculosis

Abstract

Introduction: it would be beneficial to determine what can influence sputum culture conversion.

Aims and objectives: We aimed to evaluate which factors were the most significant in sputum culture conversion after 1 month of in-hospital treatment of multidrug-resistant tuberculosis (TB).

Methods: a prospective study conducted in one of the largest TB hospitals in Lithuania. Patients with bacteriologically confirmed multidrug-resistant pulmonary TB, diagnosed for the first time in their lifetime, with no exclusion criteria (significant morbidity due to other illnesses or HIV positive) were included. There were 28 patients (16 men, 12 women). Before the treatment patients were asked about smoking, alcohol use, occupation, living conditions, education. Body mass index (BMI), chest x-ray and laboratory tests (vitamin D, albumin) were performed. Chest x-ray score was calculated by the method proposed by Ralph at al.

Results: Culture conversion after 1 month was seen in 11 (39.3%). The sputum microscopy results and chest x-ray score before the treatment was significantly different among the two groups, with higher x-ray score and more acid-fast bacilli found in the non-conversion group. Among the two groups, we found no significant difference of age, sex, BMI, smoking, education, work or family status, living conditions, vitamin D or albumin. The most important factor determining conversion after 1 month was alcohol use prior TB treatment. Those who admitted of using alcohol had a 49 times higher risk of non-conversion after 1 month (p 0,01).

Conclusions: highest risk of not converting after 1 month of treatment was seen in those patients who reported alcohol use before TB treatment.