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"[ABSTRAKLatar Belakang: Pengobatan TB MDR memiliki hasil yang buruk dengan keberhasilan hanya 48% di dunia. Salah satu indikator keberhasilan pengobatan adalah konversi dini. Identifikasi faktor yang mempengaruhi konversi merupakan hal yang penting. Metode: Penelitian ini dilakukan secara kohort retrospektif dengan menggunakan rekam medik pasien TB MDR di RSUP Persahabatan Jakarta yang berobat selama bulan Agustus 2009 - Desember 2013.Hasil: Dari 436 pasien terdapat 248 pasien laki-laki (56.6%). Sebanyak 256 pasien (58,7%) mengalami konversi biakan dalam dua bulan pengobatan. Nilai tengah waktu konversi adalah 44 hari. Faktor yang memperlambat lama konversi adalah jenis kelamin perempuan (aHR 0,808; [95%CI 0,659-0,991]), IMT pasien kurang (0,792; [0,637-0,983]), ditemukan gambaran kavitas pada foto toraks (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), riwayat pengobatan OAT sebelumnya dengan lini kedua (0,597;[0,415-0,858]), jumlah resisten obat > 2 OAT (0,614;[0,429-0,879]), kelompok pasien Pre XDR dan TB XDR (0,486;[0,305-0,776]), dan jumlah limfosit rendah (0,681;[0,524-0,885]).Kesimpulan: Jenis kelamin perempuan, IMT kurang, gambaran kavitas pada foto toraks, tingginya bacterial load, riwayat pengobatan OAT sebelumnya dengan lini kedua, jumlah resisten obat > 2 OAT, kelompok pasien Pre XDR dan TB XDR serta limpositopenia berhubungan dengan lamanya konversi pada pasien TB MDR.

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ABSTRACTIntroduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.;Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients., Introduction: Treatment for MDR-TB has a poor outcomes, success rate was only 48% worldwide. One indicator of treatment success is early culture conversion. Identification of potential factors associated with culture conversion are important.Methods: A cohort rectrospective study using medical records of MDR-TB patients of Persahabatan Hospital during August 2009 until December 2013. Data were analyzed using multivariate analysis.Results : Of a total 436 patients, there are 248 patients (56.6%) were males. Two hundred fifty six patients (58,7%) had sputum culture conversion at two months. The median time to culture conversion was 44 days. The factors for longer sputum culture conversion were female (aHR 0,808; [95%CI 0,659-0,991]), underweight patients (0,792; [0,637-0,983]), cavitaty on chest radiograph (0,781;[0,634-0,961]), bacterial load 2+ (0,617;[0,439-0,869]), bacterial load 3+ (0,701;[0,501-0,979]), previous TB treatment with second line drugs (0,597;[0,415-0,858]), resistance to more 2 TB drugs (0,614;[0,429-0,879]), pre XDR and XDR-TB (0,486;[0,305-0,776]), and lower lymphocites count (0,681;[0,524-0,885]).Conclusion: Female, underweight patients, cavitaty, high bacterial load, previous TB treatment with second line drugs, resistance to more 2 TB drugs, resistance to rifampicine, isoniazid and other second line drugs, and lower lymphocites count were associated with longer time culture conversion in MDR-TB patients.]"

"Tuberkulosis merupakan penyakit yang disebabkan oleh infeksi bakteri Mycobacterium tuberculosis dan menjadi beban global karena tingginya angka kematian. Terapi antibiotik 6 bulan menyebabkan kemungkinan adanya resistansi terhadap antibiotik lini pertama (rifampisin dan isoniazid) yang disebut sebagai Multidrug-Resistant TB (MDR-TB). Kasus MDR-TB paling banyak disebabkan oleh mutasi spontan bakteri Mycobacterium tuberculosis pada gen rpoB, gen katG, dan promotor mabA-inhA. Deteksi cepat MDR-TB bisa dilakukan dengan metode Polymerase Chain Reaction (PCR) dengan pemilihan primer yang akurat untuk mendeteksi mutasi gen Mycobacterium tuberculosis Spesifitas tiga primer yang telah didesain diuji menggunakan kontrol positif DNA dan pengujian in-silico dengan BLAST. Hasil pengujian secara in-silico dan visualisasi gel elektroforesis menunjukkan primer rpoB, katG, dan inhA spesifik mendeteksi gen target dengan nilai E-value BLAST pada rentang 10-40–10-59. Pengujian limit deteksi primer inhA menunjukkan spesifitas primer bisa mendeteksi bakteri hingga konsentrasi 1 bakteri/mL. Hasil penelitian menyimpulkan primer rpoB, katG, dan inhA spesifik terhadap gen target mutasi dan dapat digunakan sebagai primer deteksi dini PCR.

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Tuberculosis is a disease caused by infection with the bacterium Mycobacterium tuberculosis and poses a global burden due to its high mortality rate. The six-month antibiotic therapy increases the possibility of resistance to first-line antibiotics (rifampicin and isoniazid), known as Multidrug-Resistant TB (MDR-TB). Most cases of MDR-TB are caused by spontaneous mutations in Mycobacterium tuberculosis in the rpoB gene, the katG gene, and the mabA-inhA promoter. Rapid detection of MDR-TB can be done using the Polymerase Chain Reaction (PCR) method with accurately selected primers to detect mutations in Mycobacterium tuberculosis genes. The specificity of the three designed primers was tested using positive DNA controls and in-silico testing with BLAST. The results of in-silico testing and gel electrophoresis visualization showed that the rpoB, katG, and inhA primers specifically detected the target genes with BLAST E-values ranging from 10-40 to 10-59. The limit of detection testing for the inhA primer showed that the primer specificity could detect bacteria at concentrations as low as 1 bacterium/mL. The study concluded that the rpoB, katG, and inhA primers are specific to the target mutation genes and can be used as early detection primers for PCR."