{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:48:33Z","timestamp":1790218113919,"version":"4.1.0"},"reference-count":29,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,6]]},"abstract":"<jats:p>To evaluate the predictive value of time to sputum culture conversion (SCC) in predicting cure and factors associated with time to SCC and cure in multidrug-resistant tuberculosis (MDR-TB) patients, a retrospective study was conducted at programmatic management unit of drug resistant tuberculosis (TB), Peshawar. A total of 428 pulmonary MDR-TB patients enrolled at the study site from January 1, 2012 to August 31, 2014 were followed until treatment outcome was recorded. Survival analysis using Cox proportional hazards model and multivariate binary logistic regression were, respectively, used to identify factors associated with time to SCC and cure. A <jats:italic>P<\/jats:italic> value &lt; 0.05 was considered statistically significant. Overall, 90.9% patients achieved SCC, and 76.9% were cured. Previous use of second-line drugs (SLDs) (hazard ratio [HR] = 0.637; 95% confidence interval [CI] = 0.429\u20130.947), ofloxacin resistance (HR = 0.656; 95% CI = 0.522\u20130.825) and lung cavitation (HR = 0.744; 95% CI = 0.595\u20130.931) were significantly associated with time to SCC. In predicting cure, sensitivities of SCC at 2, 4, and 6 months were 64.1% (95% CI = 58.69\u201369.32), 93.0% (95% CI = 89.69\u201395.52), and 97.6% (95% CI = 95.27\u201398.94), respectively, whereas specificities were 67.7% (95% CI = 57.53\u201376.73), 51.5% (95% CI = 41.25\u201361.68), and 44.4% (95% CI = 34.45\u201354.78), respectively. Furthermore, patients\u2019 age of 41\u201360 (odds ratio [OR] = 0.202; 95% CI = 0.067\u20130.605) and &gt; 60 years (OR = 0.051; 95% CI = 0.011\u20130.224), body weight &gt; 40 kg (OR = 2.950; 95% CI = 1.462\u20135.952), previous SLD use (OR = 0.277; 95% CI = 0.097\u20130.789), lung cavitation (OR = 0.196; 95% CI = 0.103\u20130.371) and ofloxacin resistance (OR = 0.386; 95% CI = 0.198\u20130.749) were significantly associated with cure. Association of SCC with cure was substantially stronger at 6 months (OR = 32.10; 95% CI = 14.34\u201371.85) than at 4 months (OR = 14.13; 95% CI = 7.92\u201325.21). However in predicting treatment outcomes, the combined sensitivity and specificity of SCC at 4 months was comparable to SCC at 6 months. Patients with risk factors for delayed SCC were also at high risk of unsuccessful outcomes.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0936","type":"journal-article","created":{"date-parts":[[2018,4,3]],"date-time":"2018-04-03T07:00:35Z","timestamp":1522738835000},"page":"1629-1636","source":"Crossref","is-referenced-by-count":27,"title":["Validity of Time to Sputum Culture Conversion to Predict Cure in Patients with Multidrug-Resistant Tuberculosis: A Retrospective Single-Center Study"],"prefix":"10.4269","volume":"98","author":[{"given":"Arshad","family":"Javaid","sequence":"first","affiliation":[{"name":"Khyber Medical University, Peshawar, Pakistan;"},{"name":"Programmatic Management Unit of Drug-Resistant Tuberculosis, Lady Reading Hospital, Peshawar, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafees","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy and Health Sciences, University of Baluchistan,Quetta, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsar Khan","family":"Afridi","sequence":"additional","affiliation":[{"name":"Programmatic Management Unit of Drug-Resistant Tuberculosis, Lady Reading Hospital, Peshawar, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anila","family":"Basit","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Postgraduate Medical Institute, Peshawar, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer Hayat","family":"Khan","sequence":"additional","affiliation":[{"name":"Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izaz","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Biology, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Atif","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","author":"World Health Organization","year":"2016"},{"key":"b2","series-title":"Ann Intern Med","first-page":"650","article-title":"Time to sputum culture conversion in multidrug-resistant tuberculosis: predictors and relationship to treatment outcome","volume":"144","author":"Holtz","year":"2006"},{"key":"b3","series-title":"J Antimicrob Chemother","first-page":"794","article-title":"Sputum conversion among patients with pulmonary tuberculosis: are there implications for removal of respiratory isolation?","volume":"59","author":"Fort\u00fan","year":"2007"},{"key":"b4","series-title":"Lancet Respir Med","first-page":"201","article-title":"Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: a secondary analysis of data from two observational cohort studies","volume":"3","author":"Kurbatova","year":"2015"},{"key":"b5","series-title":"Indian J Med Res","first-page":"529","article-title":"Outcome of standardized treatment for patients with MDR-TB from Tamil Nadu, India","volume":"133","author":"Joseph","year":"2011"},{"key":"b6","series-title":"Eur Respir J","first-page":"1601558","article-title":"Time to sputum culture conversion and treatment outcome of patients with multidrug-resistant tuberculosis: a prospective cohort study from urban China","volume":"49","author":"Lu","year":"2017"},{"key":"b7","series-title":"Eur Respir J","first-page":"2625","article-title":"Sputum culture conversion among the first cohorts of MDR-TB patients managed in Nigeria at a tertiary care hospital","volume":"44","author":"Ige","year":"2014"},{"key":"b8","series-title":"Int J Tuberc Lung Dis","first-page":"520","article-title":"Successful management of multidrug-resistant tuberculosis under programme conditions in the Dominican Republic","volume":"17","author":"Rodriguez","year":"2013"},{"key":"b9","series-title":"Eur Respir J","first-page":"1498","article-title":"Long-term mortality assessment of multidrug-resistant tuberculosis patients treated with delamanid","volume":"45","author":"Wells","year":"2015"},{"key":"b10","author":"World Health Organization","year":"2016"},{"key":"b11","series-title":"Int J Tuberc Lung Dis","first-page":"448","article-title":"Use of Xpert (R) MTB\/RIF assay in the first national anti-tuberculosis drug resistance survey in Pakistan","volume":"20","author":"Tahseen","year":"2016"},{"key":"b12","series-title":"PLoS One","first-page":"e93206","article-title":"Predictors of two months culture conversion in multidrug-resistant tuberculosis: findings from a retrospective cohort study","volume":"9","author":"Basit","year":"2014"},{"key":"b13","series-title":"Int J Tuberc Lung Dis","first-page":"1556","article-title":"Predictors of delayed culture conversion in patients treated for multidrug-resistant tuberculosis in Pakistan","volume":"15","author":"Qazi","year":"2011"},{"key":"b14","series-title":"Eur Respir J","first-page":"1601967","article-title":"Applicability of the World Health Organization recommended new shorter regimen in a multidrug-resistant tuberculosis high burden country","volume":"3","author":"Javaid","year":"2017"},{"key":"b15","series-title":"Int J Tuberc Lung Dis","first-page":"1109","article-title":"Management and treatment outcomes of MDR-TB: results from a setting with high rates of drug resistance","volume":"19","author":"Ahmad","year":"2015"},{"key":"b16","series-title":"Eur Respir J","first-page":"156","article-title":"Resistance to fluoroquinolones and second-line injectable drugs: impact on MDR-TB outcomes","volume":"42","author":"Falzon","year":"2012"},{"key":"b17","series-title":"PLoS One","first-page":"e6914","article-title":"Treatment outcomes of multidrug-resistant tuberculosis: a systematic review and meta-analysis","volume":"4","author":"Johnston","year":"2009"},{"key":"b18","series-title":"Tuberculosis (Edinb)","first-page":"397","article-title":"Predictors of poor outcomes among patients treated for multidrug-resistant tuberculosis at DOTS-plus projects","volume":"92","author":"Kurbatova","year":"2012"},{"key":"b19","series-title":"Eur Respir J","first-page":"1155","article-title":"Resistance to second-line injectables and treatment outcomes in multidrug-resistant and extensively drug-resistant tuberculosis cases","volume":"31","author":"Migliori","year":"2008"},{"key":"b20","series-title":"Am J Infect Control","first-page":"190","article-title":"Risk factors for high death and loss-to-follow-up rates among patients with multidrug-resistant tuberculosis at a programmatic management unit","volume":"45","author":"Javaid","year":"2017"},{"key":"b21","series-title":"Global J Med Pub Health","first-page":"24","article-title":"Time to sputum conversion in multidrug-resistant tuberculosis patients in Armenia: retrospective cohort study","volume":"1","author":"Hovhannesyan","year":"2012"},{"key":"b22","series-title":"Chest","first-page":"744","article-title":"Outcomes of patients with multidrug-resistant pulmonary tuberculosis treated with ofloxacin\/levofloxacin-containing regimens","volume":"117","author":"Yew","year":"2000"},{"key":"b23","series-title":"Eur Respir J","first-page":"376","article-title":"Role of 2-month sputum smears in predicting culture conversion in pulmonary tuberculosis","volume":"37","author":"Su","year":"2011"},{"key":"b24","series-title":"Int J Tuberc Lung Dis","first-page":"1315","article-title":"Bacteriologic monitoring of multidrug-resistant tuberculosis patients in five DOTS-Plus pilot projects","volume":"15","author":"Gammino","year":"2011"},{"key":"b25","series-title":"PLoS One","first-page":"e108035","article-title":"Time to culture conversion and regimen composition in multidrug-resistant tuberculosis treatment","volume":"9","author":"Tierney","year":"2014"},{"key":"b26","series-title":"Lancet","first-page":"318","article-title":"Clinical outcome of individualised treatment of multidrug-resistant tuberculosis in Latvia: a retrospective cohort study","volume":"365","author":"Leimane","year":"2005"},{"key":"b27","series-title":"Clin Infect Dis","first-page":"634","article-title":"Malnutrition and pulmonary tuberculosis","volume":"35","author":"Byrd","year":"2002"},{"key":"b28","series-title":"N Engl J Med","first-page":"170","article-title":"The treatment of multidrug-resistant tuberculosis in Turkey","volume":"345","author":"Tahao\u011flu","year":"2001"},{"key":"b29","series-title":"PLoS One","first-page":"e0159560","article-title":"Effects of multidrug resistant 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