Predictors of Time to Sputum Culture Conversion Among Drug-Resistant Tuberculosis Patients in Oromia Region Hospitals, Ethiopia

Abstract

Purpose

Multi-drug-resistant tuberculosis occurs when the tuberculosis bacteria develop resistance to at least the two most effective first-line anti-tuberculosis drugs, isoniazid and rifampicin. Sputum culture conversion is one of the indicators to monitor patients’ prognosis throughout the treatment. Hence, this study aimed to assess time to culture conversion and its determinants among drug-resistant tuberculosis patients.

Patients and Methods

A total of 228 drug-resistant tuberculosis patients in selected hospitals in Oromia region, Ethiopia, were included in this study. Descriptive statistics like median time to sputum smear and culture conversion were computed. Bivariate and multivariate Cox proportional hazard models were used to identify the independent predictors of time to culture conversion. The adjusted hazard ratio (AHR) with 95% confidence interval (CI) was used to report the strength of association. Statistical significance was declared at p <0.05.

Results

The median age of the study participants was 28 years with inter-quartile range of (IQR) of 22–32 years, and 60% of the patients were male. The median time to culture conversion was 61 days (IQR: 34–92 days). The proportion of sputum culture conversion at 2nd, 4th, and 6th months of treatment initiation was 47%, 82.5%, and 89%, respectively. The final adjusted multivariate Cox proportional hazard model revealed that patients with massive effusion on chest radiographic finding had a 60%-decreased culture conversion time (AHR: 0.4, 95% CI: 0.1–0.9). Patients with abnormalities without cavitations (AHR: 0.5, 95% CI: 0.2–0.9) and those with uninterpreted findings (AHR: 0.3 95% CI: 0.1–0.5) had delayed culture conversion time.

Conclusion

Chest radiographic findings such as massive effusion, abnormalities without cavitations, and uninterpreted findings were found to be predictors of time to sputum culture conversion. Patients with such characteristics have prolonged culture conversion time. Hence, they may need special attention during the treatment.

Keywords:

• multi-drug-resistant tuberculosis
• tuberculosis
• time to sputum culture conversion
• predictors
• survival analysis
• treatment outcome
• Oromia
• Ethiopia

Acknowledgments

We thank Madda Walabu University for its financial support for this research. We thank all study participants, data collectors, and supervisors involved in this study.

Disclosure

The authors report no conflicts of interest in this work.