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Time to sputum culture conversion and associated factors among rifampicin-resistant pulmonary tuberculosis patients treated with Bedaquiline at Mulago hospital, Uganda
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DOI：10.1186/s12879-026-14131-7.png)
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Abstract
En 中文
Sputum culture conversion in patients with pulmonary tuberculosis (PTB) is the most important interim indicator for drug-resistant (DR) tuberculosis (TB) treatment effectiveness. Bedaquiline-based regimens offer the possibility of more effective and less toxic treatment for DR TB. Bedaquiline-based regimens have been adopted as the new standard of care for DR TB, replacing the oto-and nephrotoxic aminoglycosides. We determined the median time to sputum culture conversion (TTCC) and associated factors among RR and MDR TB patients treated with Bedaquiline-based regimens, at Mulago National Referral Hospital, Uganda. In a longitudinal type of observational study performed at Mulago Hospital, between January 2020 and June 2023, RR and MDR TB patients’ records were reviewed to obtain data on socio-demographic and clinical factors, and TTCC. The study outcome was TTCC, recorded as time from RR/MDR TB treatment initiation to sputum culture conversion, which was defined as at least 2 consecutive negative TB sputum cultures, at least 30 days apart, for a RR/MDR PTB patient who was sputum culture positive at baseline. Analysis for median TTCC was done using Kaplan-Meier analysis, and the log-logistic parametric survival regression model was used to identify predictors for TTCC. Of the 265 participants, 196 (74.0%) were male, with median age of 35(IQR:27–42) years. The median TTCC was 7 (IQR:4–8) weeks from treatment initiation. Grade 2 + baseline smear positivity (adjusted Time Ratio (aTR):1.24, 95% CI:1.02–1.51, p = 0.029), grade 3 + baseline smear positivity (aTR:1.62, 95% CI:1.30–2.01, p < 0.001), cavitary disease on CXR (aTR:1.36, 95% CI:1.18–1.56, p < 0.001), and pleural effusion on CXR (aTR:1.81, 95% CI:1.43–2.31, p < 0.001) significantly prolonged the TTCC. Diabetes mellitus (7/265) significantly reduced the TTCC (aTR: 0.37, 95% CI: 0.22 — 0.60, p < 0.001). The WHO long regimen (9 months) was indistinguishable from the shorter 6-months regimen for the time to culture conversion. Integration of TB screening at points of care of high-risk patients like diabetics remains important for early detection and prompt initiation of DR TB treatment for better outcomes. The TB program and clinicians should enhance and individualize support for RR/MDR TB patients with more severe disease, to ensure optimum TTCC and successful treatment outcomes. Not applicable.
Keywords:
Bedaquiline
Multi-drug resistant
Rifampicin-resistant
Tuberculosis
Sputum culture conversion
Uganda
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