Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India?
BACKGROUND: In India, the Revised National Tuberculosis Control Programme (RNTCP) has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB) patients. OBJECTIVES: To determine the increment...
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doaj-324670294fda4911aeb3d4c00b7a30ac2020-11-24T21:26:36ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0179e4555410.1371/journal.pone.0045554Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India?Sharath Burugina NagarajaAjay M V KumarKuldeep Singh SachdevaRanjani RamachandranSrinath SatyanarayanaAvi BansalMalik ParmarSarabjit ChadhaSreenivas NairAshok KumarSven Gudmund HinderakerMary EdgintonPuneet K DewanBACKGROUND: In India, the Revised National Tuberculosis Control Programme (RNTCP) has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB) patients. OBJECTIVES: To determine the incremental yield of the second sputum specimen during follow-up culture examinations among patients with MDR-TB and the effect on case management on changing from two to one specimen follow-up strategy. METHODS: A cross sectional record review of MDR-TB patients registered during 2008-09 under RNTCP was undertaken in three MDR-TB treatment sites of India. RESULTS: Of 1721 pairs of follow-up sputum culture examinations done among 220 MDR-TB patients, 451(26%) were positive with either of the two specimens; 29(1.7%) were culture positive only on the second specimen indicating the incremental yield. To detect one additional culture positive result on the second specimen, 59 specimens needed to be processed. If we had examined only one specimen, we would have missed 29 culture-positive results. By current RNTCP guidelines, however, a single specimen policy would have altered case management in only 3(0.2%) instances, where patients would have missed a one month extension of the intensive phase of MDR-TB treatment. There is no meaningful advantage in using two specimens for the monitoring of MDR-TB patients. A single specimen policy could be safely implemented with negligible clinical effect on MDR-TB patients and favourable resource implications for RNTCP.http://europepmc.org/articles/PMC3459961?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Sharath Burugina Nagaraja Ajay M V Kumar Kuldeep Singh Sachdeva Ranjani Ramachandran Srinath Satyanarayana Avi Bansal Malik Parmar Sarabjit Chadha Sreenivas Nair Ashok Kumar Sven Gudmund Hinderaker Mary Edginton Puneet K Dewan |
spellingShingle |
Sharath Burugina Nagaraja Ajay M V Kumar Kuldeep Singh Sachdeva Ranjani Ramachandran Srinath Satyanarayana Avi Bansal Malik Parmar Sarabjit Chadha Sreenivas Nair Ashok Kumar Sven Gudmund Hinderaker Mary Edginton Puneet K Dewan Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? PLoS ONE |
author_facet |
Sharath Burugina Nagaraja Ajay M V Kumar Kuldeep Singh Sachdeva Ranjani Ramachandran Srinath Satyanarayana Avi Bansal Malik Parmar Sarabjit Chadha Sreenivas Nair Ashok Kumar Sven Gudmund Hinderaker Mary Edginton Puneet K Dewan |
author_sort |
Sharath Burugina Nagaraja |
title |
Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? |
title_short |
Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? |
title_full |
Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? |
title_fullStr |
Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? |
title_full_unstemmed |
Is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in India? |
title_sort |
is one sputum specimen as good as two during follow-up cultures for monitoring multi drug resistant tuberculosis patients in india? |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
BACKGROUND: In India, the Revised National Tuberculosis Control Programme (RNTCP) has adopted the strategy of examining two specimens during follow-up culture examinations to monitor the treatment response of multi-drug resistant tuberculosis (MDR-TB) patients. OBJECTIVES: To determine the incremental yield of the second sputum specimen during follow-up culture examinations among patients with MDR-TB and the effect on case management on changing from two to one specimen follow-up strategy. METHODS: A cross sectional record review of MDR-TB patients registered during 2008-09 under RNTCP was undertaken in three MDR-TB treatment sites of India. RESULTS: Of 1721 pairs of follow-up sputum culture examinations done among 220 MDR-TB patients, 451(26%) were positive with either of the two specimens; 29(1.7%) were culture positive only on the second specimen indicating the incremental yield. To detect one additional culture positive result on the second specimen, 59 specimens needed to be processed. If we had examined only one specimen, we would have missed 29 culture-positive results. By current RNTCP guidelines, however, a single specimen policy would have altered case management in only 3(0.2%) instances, where patients would have missed a one month extension of the intensive phase of MDR-TB treatment. There is no meaningful advantage in using two specimens for the monitoring of MDR-TB patients. A single specimen policy could be safely implemented with negligible clinical effect on MDR-TB patients and favourable resource implications for RNTCP. |
url |
http://europepmc.org/articles/PMC3459961?pdf=render |
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