Müge AYDOĞDU, Filiz ÇİMEN, Dilek SAKA, Haluk Celaleddin ÇALIŞIR, Mihriban ÖĞRETENSOY

Kliniğimizde yeniden tedavi rejimi uygulanan akciğer tüberkülozlu olguların sonuçları

Kliniğimizde Ocak 1997-Aralık 2005 tarihleri arasında tedavi gören, Dünya Sağlık Örgütü kategorilerine göre kategori 2 tedavi grubuna dahil olan 164 insan immünyetmezlik virüsü (HIV) seronegatif akciğer tüberkülozu olgusunun kayıtları retrospektif olarak incelendi. Tüm olgular erkekti. Olguların yaş ortalaması 43.72 ± 12.73 yıl idi. Yirmi üç (%14) olgu tedavi başarısızlığından gelen olgu, 42 (%25.6) olgu nüks, 99 (%60.4) olgu tedaviyi terkten dönen olgu idi. Ortalama konversiyon süresi 2.62 ± 1.84 aydı. Konversiyon oranı nüks olgularda (%76.2), tedavi başarısızlığından gelen olgulardan (%56.5) ve tedaviyi terkten dönen olgulardan (%57.6) daha yüksekti. Yüz kırk olguda direnç testi yapıldı. Yetmiş üç (%52.1) olguda herhangi bir ilaca direnç saptandı. Kırk beş (%32.1) olguda çok ilaca direnç mevcuttu. Tüm olgular içinde, 7 (%4.3) olgu öldü. Kırk sekiz (%29.3) olgu tedaviyi terk etti. Otuz üç (%20.1) olguda kategori 2 rejimine karşı tedavi başarısızlığı gelişti. Yetmiş altı (%46.3) olgu kür oldu. Kür oranı, kontrolden çıkmamış olan olgularda %65.5 idi. Tedaviyi terkten dönen olguların %36.4’ü tedaviyi terk etti. Bu oran nüks ve tedavi başarısızlığından gelen olgulardan daha fazla idi (p= 0.014). Tedaviyi terkten dönen olgularda kür oranı (%38.4), nükslerden (%61.9) ve tedavi başarısızlığından gelen olgulardan (%52.2) anlamlı olarak daha azdı (p= 0.012). Herhangi bir direnç varlığı ile kür olma arasında ve konversiyon olması arasında anlamlı ilişki vardı. İkinci ve üçüncü ay aside dirençli basil ve kültür pozitiflikleri ile tedavi başarısı arasında anlamlı bir ilişki mevcuttu. Sonuç olarak; nüks ve tedavi başarısızlığı olan olgularda, minör ilaçlara başlama kararı vermeden önce yeniden tedavi rejimine bir şans verilebilir. Çünkü tedaviyi terkten dönen olgularla kıyaslandığında, kür oranı daha yüksektir. Tedaviyi terkten dönen olgular, tedaviyi terk etme eğilimindedir ve direnç oranları yüksektir. Çok ilaca direnç oranı tüm olgularda %32’dir ve bunların %46.7’sinde yeniden tedavi rejimi ile kür sağlanmıştır. Tedavi yanıtının bakteriyolojik olarak izlemi, tedaviye yön vermede etkilidir.

The treatment results of retreatment pulmonary tuberculosis patients in our clinic

164 human immunodeficiency virus (HIV) seronegative pulmonary tuberculosis cases treated in our clinic between January 1997 to December 2005 and included in category two treatment group were evaluated retrospectively. All the cases were male. The mean age was 43.72 ± 12.73 years. The mean duration of disease was 3.96 ± 4.80 years. The patients had used mean 4.62 ± 0.86 types of drugs. The patients were hospitalized for mean 100.54 ± 67.43 days. 23 (14%) patients were defined as treatment failure. 42 (25.6%) patients were relapse and 99 (60.4%) were defaulter. Mean time of conversion was 2.62 ± 1.84 months. Conversion rate was higher in relapse cases (76.2%) compared with treatment failure (56.5%) and defaulter (57.6%). In 140 patients, resistance tests were performed. 73 (52.1%) patients had any drug resistance. 45 (32.1%) patients had multidrug resistance. Among all the patients, 7 (4.3%) patients had died. 48 (29.3%) patients defaulted. 33 (20.1%) had treatment failure. 76 (46.3%) had cured. The cure rate was 65.5% in patients who were in control. 36.4% of defaulters were out of control. This rate was significantly higher than relapse and treatment failure cases (p= 0.014). Cure rate in defaulters (38.4%) were significantly lower than relapses (61.9%) and treatment failures (52.2%). There was a significant relationship between any drug resistance and cure and conversion. There was also a significant relationship between positive second and third ARB and culture and treatment success. As a result, a chance to retreatment regimen can be given in relapses and treatment failures before deciding minor drug therapy because they have higher cure rates than defaulters. Defaulters are hard to cure. They have the tendency to default again and they have higher resistance rates. The multi drug resistance rate in all patients was about 32% and 46.7% of these have cured with retreatment regimen. Bacteriological follow up of treatment outcome is effective in management of therapy.

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