1 The Situation of The Situation of Multidrug-Resistant Multidrug-Resistant Tuberculosis in Turkey Tuberculosis in Turkey Dr. Serir Aktoğu Özkan Dr. Serir Aktoğu Özkan Izmir Training Hospital for Izmir Training Hospital for Thoracic Diseases and Surgery Thoracic Diseases and Surgery
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The Situation of Multidrug-Resistant Tuberculosis in Turkey Dr. Serir Aktoğu Özkan
The Situation of Multidrug-Resistant Tuberculosis in Turkey Dr. Serir Aktoğu Özkan Izmir Training Hospital for Thoracic Diseases and Surgery. Contributors. Dr. Kemal Tahaoğlu Dr. Turan Karagöz Dr. Şeref Özkara Dr. Haluk Celalettin Çalışır Dr. Emel Çağlar Dr. Özlen Tümer Dr. Seren Arpaz - PowerPoint PPT Presentation
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The Situation of The Situation of Multidrug-Resistant Multidrug-Resistant
Tuberculosis in TurkeyTuberculosis in Turkey
Dr. Serir Aktoğu ÖzkanDr. Serir Aktoğu ÖzkanIzmir Training Hospital for Izmir Training Hospital for
Thoracic Diseases and SurgeryThoracic Diseases and Surgery
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ContributorsContributors Dr. Kemal TahaoğluDr. Kemal Tahaoğlu Dr. Turan KaragözDr. Turan Karagöz Dr. Şeref ÖzkaraDr. Şeref Özkara Dr. Haluk Celalettin ÇalışırDr. Haluk Celalettin Çalışır Dr. Emel ÇağlarDr. Emel Çağlar Dr. Özlen TümerDr. Özlen Tümer Dr. Seren Arpaz Dr. Seren Arpaz Dr. Tülay TörünDr. Tülay Törün Dr. Gönenç OrtaköylüDr. Gönenç Ortaköylü Dr. Onur Fevzi ErerDr. Onur Fevzi Erer
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Drug Resistance in IstanbulDrug Resistance in IstanbulDrug Resistance in IstanbulDrug Resistance in IstanbulNo drug resistance survey in Turkey No drug resistance survey in Turkey
Results from Central Laboratory of Istanbul Society Results from Central Laboratory of Istanbul Society Against Tuberculosis ,1999Against Tuberculosis ,1999
Primary and Secondary MDR-TB in Istanbul, 1990-2004
1. New case: 315 Old case: 222- IUATLD 1994 2. New case : 1046 Old case: 324)- .Eur J Clin Microbiol Infect Dis 2002 3 New case. : 1614 Old case: : 251 Toraks 2006
(1) (2) (3)
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The Multidrug resistance rates in The Multidrug resistance rates in Izmir Chest Diseases HospitalIzmir Chest Diseases Hospital
Atatürk Chest Diseases HospitalAtatürk Chest Diseases Hospital
Bed numberBed number 550550 TB bed number:TB bed number: 150 150 Number of hospitalized TB patients /year: 1500Number of hospitalized TB patients /year: 1500 The treatment of MDR-TB has been done since 1991The treatment of MDR-TB has been done since 1991 Drug susceptibilty test can be done in every patientDrug susceptibilty test can be done in every patient After evaluating for compliance, the patients are After evaluating for compliance, the patients are
treated with minör anti tb drugstreated with minör anti tb drugs There is no data regarding treatment resultsThere is no data regarding treatment results
TB bed number:TB bed number: 7878 Number of hospitalized patient: Number of hospitalized patient: 16 88416 884 Number of hospitalized TB patient:Number of hospitalized TB patient: 770770 The treatment of MDR-TB has been done The treatment of MDR-TB has been done
since 1998since 1998 270 patients with MDR TB were treated until 270 patients with MDR TB were treated until
December 2005December 2005
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Treatment results of 61 Treatment results of 61 patients with MDR-TB in Izmir patients with MDR-TB in Izmir
Chest Diseases HospitalChest Diseases HospitalPatient NoPatient No %%
CuredCured 2222 3636
CompletedCompleted 99 1515
DefaultDefault 99 1515
FailedFailed 11
DiedDied 1313 2121
TransferredTransferred 22
Lost at followupLost at followup 55
TotalTotal 6161
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Treatment resultsTreatment results of MDR-TB 1998-of MDR-TB 1998-20052005
Case Case numbernumber
%% DOT(+DOT(+))
DOT(-)DOT(-)
CuredCured 66 7575 33 33
DiedDied 22 2525 11 11
treatmtreatmentent
22 22
Nazilli Dispensary
CuredCured 33 100100 33
treatmtreatmentent
Aydın Dispensary
Dr. Seren Arpaz
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ISTANBULPopulation: 12-15 millionPoverty, migration, inequality, insufficient infrastructure2 centers for TB
Bed number : 408 Bed number : 408 (2005) (2005) Number of hospitalized patient: Number of hospitalized patient: 10 533 10 533 (2005)(2005) Number of hospitalized TB patient:Number of hospitalized TB patient: 1 697 1 697 (2005)(2005) Mean hospitalization time of TB patients:Mean hospitalization time of TB patients: 23 days 23 days MDR-TB patients were treated related to the MDR-TB patients were treated related to the
orders of The Committee of Resistance since orders of The Committee of Resistance since 20012001
Treatment results of 178 patients with MDR-Treatment results of 178 patients with MDR-TB are available in the period of 2001-2005 TB are available in the period of 2001-2005
Dr. Emel Çağlar, Dr. Gönenç OrtaköylüDr. Emel Çağlar, Dr. Gönenç Ortaköylü
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Characteristics of patients with MDR-TB Characteristics of patients with MDR-TB in Yedikule Chest Diseases Hospital in Yedikule Chest Diseases Hospital
(2001-2005) N= 178(2001-2005) N= 178
AgeAge 38 (17-66)38 (17-66)
Sex (Male/Female)Sex (Male/Female) 166/12166/12
Median no. of drugs Median no. of drugs previously usedpreviously used
4.64.6
Median no. of Median no. of resistant drugresistant drug
3.13.1
Median no. of drugs Median no. of drugs used in study used in study regimen regimen
5.95.9
SurgerySurgery 19 (%10)19 (%10)
Median Median hospitalization hospitalization
71.8 day71.8 dayDr. Emel Çağlar, Dr. Gönenç Dr. Emel Çağlar, Dr. Gönenç OrtaköylüOrtaköylü
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Characteristics of patients with Characteristics of patients with MDR-TB in Yedikule Chest MDR-TB in Yedikule Chest
Bed number : Bed number : 1020 1020 Number of hospitalized patients /year: 16 000Number of hospitalized patients /year: 16 000 Number of hospitalized TB patients /year: 2 500Number of hospitalized TB patients /year: 2 500 Treatment of MDR-TB has been done since 1992Treatment of MDR-TB has been done since 1992 Second-line drugs have been provided by Social Second-line drugs have been provided by Social
Security SystemSecurity System The patients with MDR-TB could be hospitalized for The patients with MDR-TB could be hospitalized for
long period and default rate was lowlong period and default rate was low
Drug resistanceDrug resistance 4.1 (4 - 9)4.1 (4 - 9)
Median no of drugs used in Median no of drugs used in
study regimenstudy regimen 5.4 (3 – 9)5.4 (3 – 9)
Median no of active drugsMedian no of active drugs 4.5 (1 – 8)4.5 (1 – 8)The mean duration of The mean duration of hospitalization (day)hospitalization (day)
297 patients with MDR-TB was treated 297 patients with MDR-TB was treated related to the orders of The Committee of related to the orders of The Committee of Resistance between December 1996-Resistance between December 1996-December 2004. Treatment was December 2004. Treatment was completed in 228 patients. Surgery was completed in 228 patients. Surgery was done in 46 patients.done in 46 patients.
Diagnosis was based on BACTEC method Diagnosis was based on BACTEC method and susceptibility tests. and susceptibility tests.
At least five new drugs were used:At least five new drugs were used: Aminoglycoside(minumum 6 mo) Aminoglycoside(minumum 6 mo)
Insufficient registry and reporting systemInsufficient registry and reporting system There are a lot of problems in terms of diagnosis There are a lot of problems in terms of diagnosis
of MDR-TB (over diagnosis or insufficient of MDR-TB (over diagnosis or insufficient diagnosis)diagnosis)
There are a lot of problems in management of There are a lot of problems in management of patients with MDR-TBpatients with MDR-TB
Therapy is not directly observedTherapy is not directly observed Insufficient using bacteriologic methods during Insufficient using bacteriologic methods during
followupfollowup Cure rates are low in some centersCure rates are low in some centers There is potential to solve this problem in TurkeyThere is potential to solve this problem in Turkey