Predicting Factors of Treatment Failure in Smear Positive
Pulmonary Tuberculosis: A Retrospective Cohort Study in
Bangkok Using a Combination of Symptoms and Sputum
Smear/Chest Radiography
Najeebullah Rahimy MD1,2, Viravarn Luvira MD1, Prakaykaew Charunwatthana MD, PhD1,
Sopon Iamsirithaworn MD, PhD3, Maleerat Sutherat MD1, Weerapong Phumratanaprapin MD1,
Thavisakdi Bamrungtrakul MD4, Benjaluck Phonrat MSc1
Affiliation :
1 Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
2 Department of Infectious Diseases, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
3 Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
4 Prasarnmit Hospital, Bangkok, Thailand
Background : A successful outcome of smear positive pulmonary tuberculosis [SPPTB] used as an indicator of TB control program
performance is necessary for monitoring program achievement.
Objective : To study outcomes of SPPTB and to investigate factors associated with treatment failure.
Materials and Methods: A retrospective study was conducted to identify outcomes and factors associated with failure in
HIV-seronegative, SPPTB adult patients at Prasarnmit Hospital, Bangkok, Thailand between 2003 and 2012.
Results : Two hundred ninety-one patients were enrolled. The following outcomes were notes, 78.7% cure, 1.7% completed
treatment, 5.5% failure, 10% transfer out, 3.8% default, and 0.3% died. In multiple logistic regression, the failures were statistically
associated with age over 50 years (OR 3.99, 95% CI 1.06 to 15.07), sputum smear 3+ at diagnosis (OR 6.34, 95% CI 1.71 to 23.55),
and drug resistance (OR 23.58, 95% CI 6.11 to 90.97). To predict failure, symptoms and basic laboratory results as well as sputum
smear and chest radiography [CXR] were combined. The symptoms of cough, fever, and hemoptysis plus sputum smear 3+ showed
high odd ratios of 5.17 (95% CI 1.50 to 18.67), 8.88 (95% CI 1.46 to 68.75), and 18.57 (95% CI 1.82 to 456.86), respectively. When
combining symptoms with cavitary lesion(s) in CXR, only hemoptysis in combination with cavitary lesion(s) showed a signi(cid:976)icant
association with failure (OR 8.54, 95% CI 0.87 to 205.19).
Conclusion : The WHO goal of success rate in SPPTB was not achieved. However, the risk factors of failure were identi(cid:976)ied by using
symptoms plus simple laboratory tests, which can be useful in resource-limited areas.
Keywords : Predicting failure, Smear positive pulmonary tuberculosis, Tuberculosis, Treatment outcome, Thailand
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