Demographic and microbiological characteristics and mortality status of patients diagnosed with tuberculosis and treated between 2018 and 2023

Öz

Purpose: We aimed to determine the demographic data, radiological findings, comorbid conditions, antituberculosis drug resistance rates, and tuberculosis-related mortality of patients with pulmonary and pleural tuberculosis where mycobacterium tuberculosis growth was detected in culture. Materials and methods: Data from 439 patients diagnosed with pulmonary and pleural tuberculosis in the chest diseases hospital clinic between January 2018 and December 2023 were retrospectively evaluated. Patients whose sputum, bronchial lavage and pleural fluid samples were positive for Mycobacterium tuberculosis complex in BACTEC 460 TB system medium were included in the study. We recorded the patients' demographic data, nationality, concomitant diseases, chest X-ray findings, drug resistance, and mortality status. We recorded the single, double, triple, and quadruple drug resistance rates against four main antituberculosis drugs using the Mycobacterium tuberculosis complex susceptibility tests. Results: We tested sputum from 338 patients, bronchial lavage from 87 patients, and pleural fluid culture from 14 patients. EZN staining showed that acid-resistant bacillus was present in 224 (51%). Comorbidities were Chronic Obstructive Pulmonary Disease (36.4%), hypertension (26.4%), and bronchiectasis (18.7%). The evaluation of the patients' chest x-rays revealed that 45.1% had infiltration, 33.3% had cavitation and infiltration, and 7.1% had cavitation. Exitus occured in 7.7% of the patients due to tuberculosis. Drug resistances were isoniazid 47 (10.7%), rifampin 15 (3.4%), ethambutol 4 (0.9%), streptomycin 37 (8.4%), and multidrug-resistant 15 (14 + RR (1)) (3.4%). We detected single drug resistance in 44 patients, double drug resistance in 18 patients, triple drug resistance in 2 patients, and quadruple drug resistance in 4 patients. Conclusion: Tuberculosis incidence and mortality are decreasing; it is still an important public health problem. It can be mortal, especially in patients with advanced age and comorbidities.

Anahtar Kelimeler

• Tuberculosis
• drug resistance
• comorbidities

2018 ve 2023 yılları arasında tüberküloz tanısı ile tedavi uygulanan hastaların demografik ve mikrobiyolojik özellikleri ve mortalite durumları

Öz

Amaç: Mycobacterium tuberculosis üremesi halinde saptanan akciğer ve plevra tüberkülozlu olguların demografik verileri, radyolojik bulguları, komorbid hastalıkları, antituberküloz ilaç direnç oranları ve tüberküloza bağlı mortalite oranlarının belirlenmesi amaçlandı. Gereç ve yöntem: Ocak 2018 ile Aralık 2023 arasında göğüs hastalıkları hastanesi kliniğinde akciğer ve plevra tüberkülozu tanısı konulan 439 hastanın verileri retrospektif olarak değerlendirildi. Balgam, bronş lavaj ve plevral sıvıdan alınan örneklerde, BACTEC 460 TB system besi yerinde mycobacterium tuberculosis kompleks üremesi saptanan hastalar çalışmaya alındı. Hastaların demografik verileri, uyruğu, eşlik eden hastalıkları, göğüs röntgen bulguları, ilaç direnci ve mortalite durumu kaydedildi. Mycobacterium tuberculosis kompleks duyarlılık testlerinde dört ana antitüberküloz ilacına karşı tek, çift, üçlü ve dörtlü ilaç direnci oranları kaydedildi. Bulgular: 338 hastada balgam, 87 hastada bronş lavajı, 14 hastadan plevra sıvısı kültürü gönderilmiş ve 224 hastada (%51) EZN boyama ile aside dirençli basil tespit edilmiş. Eşlik eden hastalıklar Kronik Obstrüktif Akciğer Hastalığı (%36,4), hipertansiyon (%26,4) ve bronşektazi (%18,7) olarak tespit edilmiştir. Hastaların PA Akciğer grafileri değerlendirildiğinde %45,1'inde bilateral üst zonlarda infiltrasyon, %33,3'ünde kavitasyon ve infiltrasyon, %7,1'inde ise kavitasyon mevcuttu. Hastaların %7,7'sin de tüberküloz nedeni ile exitus geliştiği belirlendi. İlaç dirençleri izoniazid 47 (%10,7), rifampin 15 (%3,4), etambutol 4 (%0,9), streptomisin 37 (%8,4) ve çoklu ilaca dirençli 15 (14 + RR (1)) (%3,4) idi. 44 hastada tek ilaç direnci, 18 hastada çift ilaç direnci, 2 hastada üçlü ilaç direnci ve 4 hastada dörtlü ilaç direnci tespit edildi. Sonuç: Tüberküloz insidansı ve mortalitesi azalmakla birlikte, hala önemli bir halk sağlığı sorunudur. Özellikle ileri yaş ve eşlik eden hastalıkların da hastalarda mortaliteyi artırdığı görülmüştür.

Anahtar Kelimeler

• Tüberküloz
• ilaç direnci
• eşlik eden hastalıklar

Kaynakça

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