Factors associated with sputum smear positive after intensive phase of treatment in pulmonary tuberculosis, Satuek Hospital, Buriram Province

Abstract

Background: Tuberculosis remains the major public health problem of Thailand. In Satuek Hospital, the incidence of pulmonary tuberculosis patients has increased steadily. In the intensive phase of treatment, it is critical to reduce the spreading of tuberculosis to other people. This objective of this study is to determine the factors associated with sputum smears not converted after intensive phase in pulmonary tuberculosis in Satuek Hospital during the years 2011-2015. Methods: Retrospective cohort study was performed to identify possible risk factors relevant to delay or non-conversion after intensive phase. Univariate and multivariate analyses were used to estimate risk ratio and adjusted odds ratio with 95% confidence interval. Result: The pulmonary tuberculosis patients enrolled in this study was 232 and sputum smears positive were 218 (93.63%). The sputum smears remained positive after intensive phase of treatment was 11.93%. The means age was 56.69 years (SD = 15.38). The majority of signs and symptoms were chronic cough (76.92%), hemoptysis (42.30%) and weight loss (19.23%). In multivariate analysis only age group >40 years (adjusted OR = 2.88, 95% CI = 1.31-9.34) and sputum acid-fast bacilli grades 3+ initially was 2 significant factors. (adjusted OR = 4.18, 95% CI = 1.43-12.22) Conclusions: The risk factors associated with sputum smears positive after intensive phase of treatment was age group >40 years and sputum acid-fast bacilli grades 3+ prior to treatment. Recommendation: surveillance in patients age group >40 years, or sputum acid-fast bacilli grades 3+ initially, sputum culture and DST (drug susceptibility testing) before starting treatment and conduct active cases finding in community and risk population should be implemented.