Diabetes Reduces the Rate of Sputum Culture Conversion in Patients With Newly Diagnosed Multidrug-Resistant Tuberculosis.

• Type of Material: Article
• Authors: Argita D. Salindri, Georgia State University; Maia Kipiani, National Center for Tuberculosis and Lung Disease; Russell Kempker, Emory University; Neel Gandhi, Emory University; Lasha Darchia, National Center for Tuberculosis and Lung Diseases; Nestani Tukvadze, National Center for Tuberculosis and Lung Disease; Henry Blumberg, Emory University; Matthew Magee, Emory University
• Language: English
• Date: 2016-06-16
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofw126
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• ISSN: 2328-8957
• Volume: 3
• Issue: 3
• Start Page: ofw126
• End Page: ofw126
• Grant/Funding Information: This study was supported in part by the National Institutes of Health (NIH) Fogarty International Center (D43TW007124), NIH National Institute of Allergy and Infectious Diseases (K23AI103044 and K24AI114444), Bethesda, Maryland; and the Atlanta Clinical and Translational Science Institute (NIH/NCATS UL1TR000454), the Laney Graduate School of Emory University, and the Emory Global Health Institute (Atlanta, GA).
• Keywords: MDR TB; diabetes; Georgia; socioeconomic status; culture conversion
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health; Health Sciences, Pathology

Abstract

Background.  Diabetes is a risk factor for active tuberculosis (TB), but little is known about the relationship between diabetes and multidrug-resistant (MDR) TB. We aimed to assess risk factors for primary MDR TB, including diabetes, and determine whether diabetes reduced the rate of sputum culture conversion among patients with MDR TB. Methods.  From 2011 to 2014, we conducted a cohort study at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia. Adult (≥35 years) patients with primary TB were eligible. Multidrug-resistant TB was defined as resistance to at least rifampicin and isoniazid. Patients with capillary glycosylated hemoglobin (HbA1c) ≥ 6.5% or previous diagnosis were defined to have diabetes. Polytomous regression was used to estimate the association of patient characteristics with drug resistance. Cox regression was used to compare rates of sputum culture conversion in patients with and without diabetes. Results.  Among 318 patients with TB, 268 had drug-susceptibility test (DST) results. Among patients with DST results, 19.4% (52 of 268) had primary MDR TB and 13.4% (36 of 268) had diabetes. In multivariable analyses, diabetes (adjusted odds ratio [aOR], 2.51; 95% confidence interval [CI], 1.00-6.31) and lower socioeconomic status (aOR, 3.51; 95% CI, 1.56-8.20) were associated with primary MDR TB. Among patients with primary MDR TB, 44 (84.6%) converted sputum cultures to negative. The rate of sputum culture conversion was lower among patients with diabetes (adjusted hazard ratio [aHR], 0.34; 95% CI, .13-.87) and among smokers (aHR, 0.16; 95% CI, .04-.61). Conclusions.  We found diabetes was associated with an increased risk of primary MDR TB; both diabetes and smoking were associated with a longer time to sputum culture conversion.