Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan.
Culture conversion is an interim monitoring tool for treatment of multidrug-resistant tuberculosis (MDR-TB). We evaluated the time to and predictors of culture conversion in pulmonary MDR-TB patients enrolled in the community-based MDR-TB management program at the Indus Hospital in  Karachi, Pakistan. Despite strict daily directly observed therapy, monthly food incentives and patient counseling, the median time to culture conversion was 196 days (range 32-471). The cumulative probabilities of culture conversion by 2, 4, 6 and 12 months were respectively 6%, 33%,  47%, and 73%. Smoking, high smear grade at baseline and previous use of second-line drugs delayed culture conversion.
Interactive Research and Development, Karachi, Pakistan. fahad.qazi@irdresearch.org
F
F
Qazi
U
U
Khan
S
S
Khowaja
M
M
Javaid
A
A
Ahmed
N
N
Salahuddin
H
H
Hussain
M C
MC
Becerra
J E
JE
Golub
A J
AJ
Khan
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001431:Bacteriological Techniques; D023801:Directly Observed Therapy; D016903:Drug Monitoring / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000254:growth & development / Q000302:isolation & purification; D010154:Pakistan / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult
D000995:Antitubercular Agents