title: Bacteriologic monitoring of multidrug-resistant tuberculosis patients in five DOTS-Plus pilot projects.
abstract: BACKGROUND
  Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries.
  
  
  OBJECTIVE
  To calculate sputum conversion time and its relationship to treatment outcome, document the frequency of culture reversions and examine concordance of smear and culture to assess the potential consequences of monitoring by smear microscopy alone.
  
  
  METHODS
  Retrospective cohort analysis of 1926 patients receiving individualized, second-line therapy.
  
  
  RESULTS
  Among 1385 sputum culture-positive cases at baseline, 1146 (83%) experienced at least one culture conversion during treatment. Conversion, however, was not sustained in all patients: 201 (15%) experienced initial culture conversion and at least one subsequent culture reversion to positive; 1064 (77%) achieved sustained culture conversion. Median time to culture conversion was 3 months. Among 206 patients whose nal conversion occurred 7-18 months after the initiation of therapy, 71% were cured or had completed treatment.
  
  
  CONCLUSIONS
  Prolonged treatment for patients with delayed conversion may be beneficial, as 71% of late converters still achieved cure or completed treatment. This has implications for programs with de ned end points for treatment failure. The interval between rst and nal conversion among patients whose initial con- version is not sustained raises concern with respect to the ongoing debate regarding duration of treatment and the definition of cure.
authors.affiliation: Division of Tuberculosis Elimination, US Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. vmg0@cdc.gov
authors.forename: V M
authors.initials: VM
authors.lastname: Gammino
authors.forename: A B
authors.initials: AB
authors.lastname: Taylor
authors.forename: M L
authors.initials: ML
authors.lastname: Rich
authors.forename: J
authors.initials: J
authors.lastname: Bayona
authors.forename: M C
authors.initials: MC
authors.lastname: Becerra
authors.forename: C
authors.initials: C
authors.lastname: Bonilla
authors.forename: I
authors.initials: I
authors.lastname: Gelmanova
authors.forename: V
authors.initials: V
authors.lastname: Hollo
authors.forename: E
authors.initials: E
authors.lastname: Jaramillo
authors.forename: S
authors.initials: S
authors.lastname: Keshavjee
authors.forename: V
authors.initials: V
authors.lastname: Leimane
authors.forename: C D
authors.initials: CD
authors.lastname: Mitnick
authors.forename: M I D
authors.initials: MI
authors.lastname: Quelapio
authors.forename: V
authors.initials: V
authors.lastname: Riektsina
authors.forename: T E
authors.initials: TE
authors.lastname: Tupasi
authors.forename: C D
authors.initials: CD
authors.lastname: Wells
authors.forename: M
authors.initials: M
authors.lastname: Zignol
authors.forename: P J
authors.initials: PJ
authors.lastname: Cegielski
mesh_terms: D000995:Antitubercular Agents / Q000008:administration & dosage*; D001431:Bacteriological Techniques; D023801:Directly Observed Therapy; D004334:Drug Administration Schedule; D016903:Drug Monitoring / Q000379:methods*; D024901:Drug Resistance, Multiple, Bacterial; D004957:Estonia; D005260:Female; D006801:Humans; D007844:Latvia; D008297:Male; D008826:Microbial Sensitivity Tests; D008853:Microscopy; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D010568:Peru; D010679:Philippines; D010865:Pilot Projects; D012189:Retrospective Studies; D012426:Russia; D013183:Sputum / Q000382:microbiology; D013997:Time Factors; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents