Publication: Çok ilaca dirençli tüberküloz hastalarında saptanan etionamid direncinin klinik önemi
Abstract
Daha önce ikinci seçenek ilaç kullanmamış Çok İlaca Dirençli (ÇİD) Tüberküloz (TB) hastalarındaki etionamid direncini, direncin basil negatifleşme süresine etkisini araştırdığımız bu çalışmada, Ağustos 2004-Mayıs 2005’te Heybeliada, Süreyyapaşa ve Yedikule Göğüs Hastalıkları Hastaneleri’nde tedavi gören 50 ÇİD olgusuna izoniazid (H), rifampisin (R), ethambutol (E), streptomisin (S) ve etionamide(Ethio) duyarlılık testi yapıldı. Etionamide duyarlılık indirekt radyometrik ve agar proporsiyon yöntemlerinin her ikisiyle de çalışıldı. En az H+R dirençli 50 olgunun 11’i (%22) BACTEC yöntemi ile etionamide karşı da dirençli bulundu. 11 olgunun %27.3’ü (3 olgu) yeni, %72.7’si (8 olgu) eski olguydu. 18 yeni olgunun %16.6’sı (3 olgu), 32 eski olgunun %25’i (8 olgu) etionamid dirençliydi. Etionamid dirençli olguların negatifleşme süresi ortalama 75.18 gün, duyarlı olgularınki ise 50.03 gündü (p<0.05). Balgam konversiyonunda olası etkili parametreler incelendi. Homojen iki grup olan etionamid dirençli ve duyarlı olgular karşılaştırıldığında etionamid direnci yanında radyolojik yaygınlık ve ileri yaşın negatifleşme zamanını uzattığı, diğer parametrelerin etkisiz kaldığı saptandı. Çalışmamız sonucunda bulunan %22 oranındaki etionamid direncinin balgam konversiyonunda gecikmeye yol açtığı, ÇİD TB hastalarına tedavi başlanmadan önce diğer ikinci seçenek ilaçlar gibi etionamid duyarlılığının da araştırılması gerektiği kanaatindeyiz.
We evaluated the presence of Ethionamide (Ethio) resistance and its effect on the time of sputum smear negativity in multidrug-resistant tuberculosis (MDR TB) patients who had not been given any second line drugs previously. Drug sensitivity tests to isoniazid, rifampicine, ethambutol, streptomycine, and ethionamide were performed on the sputum of 50 patients treated in Heybeliada, Süreyyapaşa, and Yedikule Hospitals between August 2004 - May 2005. Both indirect agar proportion and BACTEC methods were used to determine Ethio sensitivity. Eleven (22%) of patients who were least resistant to isoniacide and rifampicine were found to be resistant to Ethio with the BACTEC method. Of these 11 cases, 3 (27.3%) were new patients and 8 (72.7%) were having re-treatment. 16.6% (3 cases) of 18 new patients were resistant to Ethio,while the resistance ratio was 25% (8 cases) for the 32 re-treatment patients. Mean sputum smear negativity was 75.18 days for Ethio resistant cases and 50.03 days for Ethio sensitive cases (p<0.05). Other parameters with a potential effect on sputum conversion time were also examinedl. Both Ethio resistant and sensitive groups were homogeneous for these factors. We found that not only Ethio resistance but also age and radiologically advanced disease were parameters affecting sputum conversion time adversely. Ethio resistance was 22% in our MDR-TB cases.
We evaluated the presence of Ethionamide (Ethio) resistance and its effect on the time of sputum smear negativity in multidrug-resistant tuberculosis (MDR TB) patients who had not been given any second line drugs previously. Drug sensitivity tests to isoniazid, rifampicine, ethambutol, streptomycine, and ethionamide were performed on the sputum of 50 patients treated in Heybeliada, Süreyyapaşa, and Yedikule Hospitals between August 2004 - May 2005. Both indirect agar proportion and BACTEC methods were used to determine Ethio sensitivity. Eleven (22%) of patients who were least resistant to isoniacide and rifampicine were found to be resistant to Ethio with the BACTEC method. Of these 11 cases, 3 (27.3%) were new patients and 8 (72.7%) were having re-treatment. 16.6% (3 cases) of 18 new patients were resistant to Ethio,while the resistance ratio was 25% (8 cases) for the 32 re-treatment patients. Mean sputum smear negativity was 75.18 days for Ethio resistant cases and 50.03 days for Ethio sensitive cases (p<0.05). Other parameters with a potential effect on sputum conversion time were also examinedl. Both Ethio resistant and sensitive groups were homogeneous for these factors. We found that not only Ethio resistance but also age and radiologically advanced disease were parameters affecting sputum conversion time adversely. Ethio resistance was 22% in our MDR-TB cases.