Semih HALEZEROĞLU, Cüneyt SALTÜRK, Turan KARAGÖZ, Tuncer ŞENOL, Pınar PAZARLI, Yetiş Dildar DUMAN, Yazıcıoğlu Özlem MOÇİN, Gülcihan DUMAN, Özge ÜNAL

The treatment results of patients with multidrug resistant tuberculosis and factors affecting treatment outcome

Çok ilaca dirençli tüberküloz (ÇİD-TB) tedavisi kompleks bir tedavidir ve sonuçlar her zaman tatmin edici değildir. Çalışmamızda hastalarımızın tedavi sonuçlarını, nüks oranlarını ve tedavi sonuçlarını etkileyen faktörleri incelemeyi amaçladık. Ocak 1995-Aralık 2000 tarihleri arasında, Süreyyapaşa Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesindeki kliniğimizde, ÇİD-TB tanısı ile tedavi gören 142 hastayı ileriye dönük olarak inceledik. Tüm hastalarımız erkek ve insan immünyetmezlik virüsü negatif hastalardı. Yaş ortalaması 39 ± 11 (16-65) idi. Tedavide, biri parenteral olmak üzere, ortalama 5.5 ± 0.8 (4-8) adet ikinci sıra tüberküloz ilaçları kullanıldı. Yüz kırk iki hastanın 102 (%71.8)’sinde kür sağlandı. Tedavi başarısızlığı 10 (%7.0) hastada görüldü. Hastaların 16 (%11.3)’sı tedaviyi terketti ve 14 (%9.9) hasta tedavi sırasında kaybedildi. Cerrahi rezeksiyon 35 hastaya uygulandı ve bunların %88.5’inde kür sağlandı. Kür olan 102 hastanın 89 (%87.2)’u takip edildi ve ortalama takip süresi 19.2 ± 10.3 (12-72) aydı. Hiçbirinde nüks saptanmadı. Başarısız tedavi sonucu olan hasta grubunda; önceki tedavi rejimlerinde protionamid ve ofloksasin kullanım sıklığı, ikinci sıra tüberküloz ilaçlarının kullanım sıklığı ve sayısı, yaygın radyolojik tutulumu olan olguların sıklığı ve ilaç yan etkisi nedeniyle ilaçların kesilme oranı daha yüksekti. Sınırlı radyolojik tutulum, protionamidin daha önceki tedavi rejimlerinde kullanılmamış olması ve adjuvan cerrahi, tedavi başarısını etkileyen bağımsız faktörler olarak tespit edildi. ÇİD-TB, karmaşık, müdahalesi zor ancak tedavi edilebilir bir hastalıktır. Tedavi sonucuna etki eden faktörlerin iyi bilinmesi ve uygun koşulların sağlanması, gelecekte başarı oranlarının daha da artmasını sağlayacaktır.

Çok ilaca dirençli tüberküloz hastalarının tedavi sonuçları ve tedavi sonucunu etkileyen faktörler

The treatment of multi-drug resistant tuberculosis (MDR-TB) is complicated and results are not always satisfactory. We aimed to investigate treatment results of our patients, relapse rates, factors affecting treatment outcome. We evaluated prospectively, 142 patients, who had been hospitalised with diagnosis of MDR-TB in our clinic between January 1995-December 2000 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital in Istanbul, Turkey. All patients were male and human immunodeficiency virus negative. The mean age was 39 ± 11 (16-65) years. A mean number of 5.5 ± 0.8 (4-8) second line drugs, including one parenteral drug, were administered. Of 142 patients, 102 (71.8%) were classified as cured, 16 (11.3%) patients were defaulters, failure was seen in 10 (7.0%) patients and 14 (9.9%) patients died during treatment. Surgical resection was applied in 35 patients and cure was achieved in 88.5% of them. Of 102 patients who were cured, 89 (87.2%) were available for follow up and mean duration of follow up was 19.2 ± 10.3 (12-72) months. Relapse was not detected in any of them. Patients with unsuccessful outcomes had a higher incidence and higher mean number of second-line drugs usage in previous regimens, higher incidence of antecedent prothionamide and ofloxacin usage, higher incidence of extensive radiologic involvement and withdrawal of responsible drugs due to adverse effects. Limited radiologic invovement, non-usage of antecedent prothionamide and adjuvant surgery were found as significant independent factors effecting successful treatment outcome. MDR-TB is a complex but a treatable disease. To know much more about the factors effecting treatment results and to arrange the proper conditions, are expected to make increases in the success rates of MDR-TB treatment.

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