Time to detection of Mycobacterium tuberculosis in sputum culture correlates with outcome in patients receiving treatment for pulmonary tuberculosis.
OBJECTIVE
The purpose of this study was to determine whether the time to detection (TTD) of Mycobacterium tuberculosis in sputum culture correlates with the response to antituberculous treatment in patients with pulmonary tuberculosis.


METHODS
Twenty-six consecutive patients were studied who had active pulmonary tuberculosis and sufficient sputum cultures and clinical follow-up to allow adequate assessment.


RESULTS
Following initiation of antituberculous therapy, 13 patients (group 1, responders) had a complete response to treatment, and the TTD of M tuberculosis using the mycobacterial growth indicator tube increased steadily. The remaining 13 patients (group 2, nonresponders) had persistent evidence of active disease and demonstrated little or no increase in the TTD with treatment unless an additional therapeutic intervention was implemented (surgery, improved compliance with medications, or a change in medications). The presence of HIV infection, intravenous drug use, multidrug resistance, treatment with second-line therapy, extensive radiographic involvement, and cavitary disease were associated with a delayed increase in the TTD.


CONCLUSIONS
The TTD was superior to clinical, radiographic, or conventional bacteriologic evaluation in determining treatment outcome. The TTD closely correlates with the overall response to treatment for pulmonary tuberculosis and may represent a useful adjunct to predict outcome in these patients.
Epstein
M D
MD
Department of Medicine, Bellevue Chest Service, NYU Medical Center, New York, NY 10016, USA.
Schluger
N W
NW
Davidow
A L
AL
Bonk
S
S
Rom
W N
WN
Hanna
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000254:growth & development / Q000302:isolation & purification*; D010349:Patient Compliance; D011859:Radiography; D012074:Remission Induction; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013183:Sputum / Q000382:microbiology*; D015819:Substance Abuse, Intravenous / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000601:surgery; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery
D000995:Antitubercular Agents