%0 Journal Article
%T Diabetes Mellitus, Smoking Status, and Rate of Sputum Culture Conversion in Patients with Multidrug-Resistant Tuberculosis: A Cohort Study from the Country of Georgia
%A Matthew J. Magee
%A Russell R. Kempker
%A Maia Kipiani
%A Nestani Tukvadze
%A Penelope P. Howards
%A K. M. Venkat Narayan
%A Henry M. Blumberg
%J PLOS ONE
%D 2014
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0094890
%X Introduction Diabetes mellitus (DM) is a risk factor for active tuberculosis (TB) but little is known about the effect of DM on culture conversion among patients with multidrug-resistant (MDR)-TB. The primary aim was to estimate the association between DM and rate of TB sputum culture conversion. A secondary objective was to estimate the association between DM and the risk of poor treatment outcomes among patients with MDR-TB. Materials and Methods A cohort of all adult patients starting MDR-TB treatment in the country of Georgia between 2009每2011 was followed during second-line TB therapy. Cox proportional models were used to estimate the adjusted hazard rate of sputum culture conversion. Log-binomial regression models were used to estimate the cumulative risk of poor TB treatment outcome. Results Among 1,366 patients with sputum culture conversion information, 966 (70.7%) had culture conversion and the median time to conversion was 68 days (interquartile range 50每120). The rate of conversion was similar among patients with MDR-TB and DM (adjusted hazard ratio [aHR] 0.95, 95%CI 0.71每1.28) compared to patients with MDR-TB only. The rate of culture conversion was significantly less in patients that currently smoked (aHR 0.82, 95%CI 0.71每0.95), had low body mass index (aHR 0.71, 95%CI 0.59每0.84), second-line resistance (aHR 0.56, 95%CI 0.43每0.73), lung cavities (aHR 0.70, 95%CI 0.59每0.83) and with disseminated TB (aHR 0.75, 95%CI 0.62每0.90). The cumulative risk of poor treatment outcome was also similar among TB patients with and without DM (adjusted risk ratio [aRR] 1.03, 95%CI 0.93每1.14). Conclusions In adjusted analyses, DM did not impact culture conversion rates in a clinically meaningful way but smoking did.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0094890