A Retrospective Case-Control Study, Factors Affecting Treatment Outcomes for Pulmonary Tuberculosis in İstanbul, Turkey

Abstract

Background: Tuberculosis is a public health problem and its transmission is a threat to the community. Aims: The aim of this study was to determine the factors influencing the treatment outcomes and the effectiveness of the National Tuberculosis Program (NTP) in relation to the application of the directly observed treatment, short-course (DOTS) program in various sites in Istanbul, Turkey. Study Design: Case-Control Study Methods: A case-control study was used, where cases and controls were randomly selected from the Turkish Tuberculosis National Database, which includes complete data on treatment outcomes for patients recorded in the database from January 1, 2006 to December 31, 2009 and had one year follow-up. Results: The case group was composed of 464 patients with adverse outcome, while the control group was composed of 441 patients who had been cured of disease. Factors associated with adverse treatment outcome were >65 years of age (OR: 3.39 (1.99-5.76)) ; male gender (OR:2.11 (1.49-2.99)); born outside Turkey (OR: 5.48 (2.13-14.04)); co-morbidity (OR: 1.85 (1.29-2.65)); bilateral radiologic lesions (OR: 2.07 (1.41-3.00); previous treatment history (OR: 3.99 (2.78-5.74)); 3rd month positive microscopy (OR: 4.96 (3.04-8.09)) and any H&R +/- others multidrug resistant (MDR) resistance (OR: 22.64 (6.92-74.08)). There was no association between the adverse treatment outcome and the application site of direct observation treatment, short course (DOTS) delivery and the supervisors. Conclusion: Our findings indicate similar quality in DOTS application and supervision among patients with or without adverse treatment outcomes. However, patients with certain characteristics should be carefully monitored and aggressively treated. Turkish Başlık: Geriye dönük Vaka-Kontrol Çalışması, İstanbul'da Akciğer Tüberkülozu Tedavi Sonuçlarını Etkileyen Faktörler Anahtar Kelimeler: Tüberkülozis, Tedavi sonucu, etkileyen faktörler Arka Plan: Tüberküloz bir halk sağlığı problemidir ve bulaşı toplum sağlığını tehtit etmektedir. Amaç: Bu çalışmanın amacı, İstanbul'da tedavi sonuçlarını etkileyen faktörleri ve DOTS uygulamı ile ilgili NTP'nin etkinliğini araştırmaktı. Çalışma Tasarımı: Olgu kontrol çalışması Yöntemler: 1 Ocak 2006, 31 Aralık 2009 tarihleri arasında kayıtlı ve bir yıllık takipleri olan Ulusal Tüberkülozis verilerinden, 18 yaş üstündeki bakteriyolojik olarak konfirme 11,186 Akciğer Tüberküloz hastası'nın tedavi Sonuçları kötü tedavi sonucu (tedavi başarısızlığı, tedavi terki, ölüm) ve tedavi başarısı (kür ve tedavi tamamlama) olarak gruplandırılmıştır. Bulgular: Vaka grubu, kötü tedavi sonucuna sahip 464 akciğer tüberkülozu hastası ve Kontrol grubu, kür tedavi sonucuna sahip 441 akciğer tüberkülozu hastası ile oluşturulmuştur. Kötü tedavi sonucu ile ilişkili faktörler; > 65 yaş (OR: 3.39 (1.99 -5.76)), erkek cinsiyeti (OR:2.11 (1.49 – 2.99)), yabancı uyruklu olma (OR: 5.48 (2.13 -14.04), ek hastalık varlığı (OR: 1.85 (1.29 -2.65)), bilateral radyolojik lezyonlar (OR: 2.07 (1.41-3.00), daha önce tedavi öyküsünün bulunması (OR: 3.99 (2.78-5.74)), 3. Ayda balgam yayma ARB (+) olması (OR: 4.96 (3.04-8.09)) ve H & R +/- diger (ÇİD) resistans (OR: 22.64 (6.92-74.08) olarak bulunmuştur. Kötü tedavi sonuçları ile DOT uygulaıma yerleri ve gözetmenleri arasında ilişki bulunmamıştır. Sonuç: Çalışmamızın bulguları, tüm hastalarda DOT'un uygulama yeri ve gözetmeler açısından aynı kalitede uygulandığını göstermektedir. Bununla birlikte kötü tedavi sonucu ile ilişkili kesin karakteristiklere sahip hastalar, dikkatli takip ve tedavi edilmelidir.

Keywords

• Tuberculosis, treatment outcome, affecting factors

A Retrospective Case-Control Study, Factors Affecting Treatment Outcomes for Pulmonary Tuberculosis in İstanbul, Turkey

Öz

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