BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: 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. DESIGN: 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.
BACKGROUND: Multidrug-resistant tuberculosis programs in DOTS-Plus pilot sites in five countries. OBJECTIVES: 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. DESIGN: 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: Sarah E Smith; Julia Ershova; Natalia Vlasova; Elena Nikishova; Irina Tarasova; Platon Eliseev; Andrey O Maryandyshev; Igor G Shemyakin; Ekaterina Kurbatova; J Peter Cegielski Journal: Emerg Infect Dis Date: 2015-06 Impact factor: 6.883
Authors: Carole D Mitnick; Richard A White; Chunling Lu; Carly A Rodriguez; Jaime Bayona; Mercedes C Becerra; Marcos Burgos; Rosella Centis; Theodore Cohen; Helen Cox; Lia D'Ambrosio; Manfred Danilovitz; Dennis Falzon; Irina Y Gelmanova; Maria T Gler; Jennifer A Grinsdale; Timothy H Holtz; Salmaan Keshavjee; Vaira Leimane; Dick Menzies; Giovanni Battista Migliori; Meredith B Milstein; Sergey P Mishustin; Marcello Pagano; Maria I Quelapio; Karen Shean; Sonya S Shin; Arielle W Tolman; Martha L van der Walt; Armand Van Deun; Piret Viiklepp Journal: Eur Respir J Date: 2016-09-01 Impact factor: 16.671
Authors: Ekaterina V Kurbatova; J Peter Cegielski; Christian Lienhardt; Rattanawadee Akksilp; Jaime Bayona; Mercedes C Becerra; Janice Caoili; Carmen Contreras; Tracy Dalton; Manfred Danilovits; Olga V Demikhova; Julia Ershova; Victoria M Gammino; Irina Gelmanova; Charles M Heilig; Ruwen Jou; Boris Kazennyy; Salmaan Keshavjee; Hee Jin Kim; Kai Kliiman; Charlotte Kvasnovsky; Vaira Leimane; Carole D Mitnick; Imelda Quelapio; Vija Riekstina; Sarah E Smith; Thelma Tupasi; Martie van der Walt; Irina A Vasilyeva; Laura E Via; Piret Viiklepp; Grigory Volchenkov; Allison Taylor Walker; Melanie Wolfgang; Martin Yagui; Matteo Zignol Journal: Lancet Respir Med Date: 2015-02-26 Impact factor: 30.700
Authors: Peter Cegielski; Paul Nunn; Ekaterina V Kurbatova; Karin Weyer; Tracy L Dalton; Douglas F Wares; Michael F Iademarco; Kenneth G Castro; Mario Raviglione Journal: Emerg Infect Dis Date: 2012-11 Impact factor: 6.883
Authors: Carole D Mitnick; Carly A Rodriguez; Marita L Hatton; Grania Brigden; Frank Cobelens; Martin P Grobusch; Robert Horsburgh; Christoph Lange; Christian Lienhardt; Eyal Oren; Laura J Podewils; Barbara Seaworth; Susan van den Hof; Charles L Daley; Agnes C Gebhard; Fraser Wares Journal: PLoS One Date: 2016-05-25 Impact factor: 3.240