Latar Belakang: Tuberkulosis resistan obat (TB-RO) masih menjadi masalah kesehatan global, penyakit utama penyebab kematian kasus infeksi tunggal terbanyak setelah Corona virus disease 2019 (COVID-19). Tahun 2021 secara global terdapat 167.000 orang dengan TB Multi Drug Resistant/Rifampicin Resistant (MDR/RR) terkonfirmasi, 162.000 memulai terapi. Angka keberhasilan global pengobatan TB RR/MDR sebesar 60%, sedangkan di Indonesia sebesar 47%. WHO merekomendasikan paduan bebas injeksi untuk TB-RO tahun 2019 meningkatkan angka keberhasilan 60% menjadi 73% dan menurunkan angka putus berobat 17,3% menjadi 9,9%. Pengobatan OAT all-oral direkomendasikan di Indonesia sejak 2020 termasuk paduan individual. Penelitian ini bertujuan untuk mengetahui luaran pengobatan TB-RO dengan paduan individual all-oral serta faktor apa saja yang memengaruhi keberhasilan pengobatan TB-RO di RSUP Persahabatan.Metode: Desain penelitian ini adalah kohort retrospektif menggunakan data rekam medis fisik dan elektronik, dilakukan di Poli TB-RO RSUP Persahabatan Oktober 2022, dengan teknik total sampling. Subjek penelitian adalah pasien TB-RO yang mendapatkan paduan individual all-oral dan memulai terapi Januari2020-Desember 2021 di poli TB-RO RSUP Persahabatan yang memenuhi kriteria penelitian.Hasil: Didapatkan 162 subjek penelitian dengan karakteristik median usia 44 (18−74) tahun, 61,7% laki-laki dan 52,5% subjek dengan IMT<18,5 kg/m2. Komorbid terbanyak adalah DM tipe 2 dengan proporsi 37%. Jenis resistansi terbanyak TB-MDR 45,1% dengan proporsi bacterial load terbanyak BTA negatif (25,9%). Proporsi konversi biakan sputum ≤ 2 bulan 56,2%. Terdapat 86,4% subjek mengalami intoleransi obat dengan proporsi terbanyak gastrointestinal 66,2%. Luaran berhasil sebesar 43,2%, meninggal 40,1%, putus berobat 13,6% dan gagal 3,1%. Analisis multivariat mendapatkan bacterial load dan kecepatan konversi merupakan faktor-faktor yang memengaruhi keberhasilan pengobatan TB-RO.Kesimpulan: Luaran berhasil pasien TB-RO yang menggunakan paduan individual all-oral 43,2%, meninggal 40,12%, gagal 3,09% dan putus berobat 13,6%. Bacterial load,BTA ≤1+ dan kecepatan konversi ≤ 2 bulan merupakan faktor yang memengaruhi keberhasilan pengobatan TB-RO dengan paduan individual all-oral. Nilai odds masing-masing faktor berturut-turut aOR:2,35 (95%IK: 1,12-4,90) dan aOR: 2,2 (95%IK: 1,05-4,61).
Background: Drug-resistant tuberculosis (DR-TB) is still the global health problem, the leading cause of death in the single infectious case after Corona virus disease 2019 (COVID-19). Globally, there were 167.000 confirmed cases of Multi Drug Resistant/Rifampicin Resistant tuberculosis (MDR/RR-TB) in 2021 and 162.000 started treatment. Global success rate for MDR/RR-TB treatment reach 60% while in Indonesia 47%. In 2019 WHO recommended injection-free regimen that increase treatment success rate of DR-TB treatment from 60% to 73% and lower lost to follow up (LTFU) cases 17,3% to 9,9%. Indonesia started all-oral regimen in 2020 consist of shorter and longer regimen. Aim of this study is to observe outcomes of drug-resistant tuberculosis (DR-TB) treated with long term all-oral regimen and factors that influence the success rate of DR-TB treatment at Persahabatan Hospital Jakarta.Metods: Design of the study was retrospective cohort using secondary data, physical and electronic medical records. It carried out in October 2022 at DR-TB clinic Persahabatan Hospital with total sampling technique. Subject of this study were medical records of DR-TB patients enrolled with long-term all-oral regimen treatment by January 2020-December 2021 which met the inclusion criteria.Results: There were 162 subjects with median of age 44 (18-74) years old, 61,7% were male, and 52,5% subject were malnutrition. Proportion of DM type 2 comorbid was 37%. MDR-TB were found in 45,1% of subject with the high proportion of negative smear bacterial load (25,9%) as baseline. Amount of sputum Mtb culture conversion within 2 months reached 56,2%. There were 86,4% subjects experiencing drug intolerance with the highest proportion being gastrointestinal 66,2%. Outcomes of the long-term DR-TB treatment were successful 43,2%, died 40,1%, dropped-out 13,6% and failed 3,1%. Multivariate analysis found that bacterial load and time of sputum conversion were factors that associated with DR-TB success rate treatment.Conclusion: Outcomes of drug-resistant tuberculosis (DR-TB) treated with long term all-oral regimen 43,2% cured, 40,12% died, dropped-out from treatment 13,6% and failed 3,1%. Bacterial load ≤1+ and time of sputum conversion ≤2 months were factors that associated with DR-TB success rate treatment with adjusted aOR:2,35 (CI95% :1,12-4,90) and aOR:2,2 (CI95% : 1,05-4,61) respectively. |
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