Tesis

Faktor Prediktor Keberhasilan Terapi Tuberkulosis Ekstra Paru dengan Menggunakan Strategi DOTS di RSUPN Dr. Cipto Mangunkusumo, Jakarta = Predictors of Success Factors of Extrapulmonary Tuberculosis Treatment Using DOTS Strategy in RSUPN Dr. Cipto Mangunkusumo, Jakarta.

Latar belakang. Tuberkulosis (TB) ekstra paru merupakan penyakit yang banyak ditemukan di Indonesia, disamping TB paru. Belum banyak penelitian mengenai TB ekstra paru di Indonesia, khususnya keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS. Belum didapatkan laporan penelitian mengenai faktor prediktor yang mempengaruhi keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS di Indonesia. Tujuan. Mengetahui faktor prediktor keberhasilan terapi tuberkulosis ekstra paru seperti usia, jenis kelamin, diabetes mellitus, HIV dan riwayat antituberkulosis. Mengetahui tingkat keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS, bila diberikan selama minimum 9 bulan. Hasil. Penelitian kohort retrospektif dengan data register DOTS TB dan data rekam medis dari 1 Januari 2008 sampai 31 Desember 2012. Didapat 542 pasien TB ekstra paru, 279 pasien TB kombinasi ekstra paru dan TB paru, 70 pasien data tidak lengkap, dan hanya 193 pasien TB ekstra paru murni. Mayoritas pasien berjenis kelamin perempuan (52,3%). Umumnya usia muda (18-60 tahun (95.9%)), rerata 31,34 + 11,64 tahun. TB ekstra paru yang paling banyak didapat adalah limfadenitis TB. Keberhasilan terapi TB ekstra paru pada usia 18-60 tahun terjadi pada 49,7% pasien (OR 2,968, 95% CI 0,584-15,087, p 0,313). Keberhasilan terapi TB ekstra paru untuk jenis kelamin perempuan didapat 55,4% pasien (OR 1,768, 95% CI 0,999-3,131, p0,05). Keberhasilan terapi TB ekstra paru pada pasien diabetes mellitus 33,3% (OR 1.957, 95% CI 0.475-8.062, p 0,546) dan pada riwayat TB sebelumnya sekitar 55,6% (OR 0.738, 95% CI 0.2781.959, p 0,717). Keberhasilan terapi TB ekstra paru pada pasien HIV 32,1% (OR 2.588, 95% CI 1.330-5.038, p 0,007). Pada analisis multivariate, keberhasilan terapi TB ekstra paru dengan faktor ko- infeksi HIV, OR 2.588, CI 95% 1.330-5.038, p 0,005. TB ekstra paru pada pasien HIV mempunyai keberhasilan terapi rendah dengan menggunakan strategi DOTS dan berhubungan dengan kegagalan terapi, serta prognosis buruk. Angka keberhasilan TB ekstra paru yang diterapi dengan menggunakan strategi DOTS selama < 9 bulan adalah 20,2%. Sebanyak 94,6% pasien TB ekstra paru berhasil diterapi dengan menggunakan strategi DOTS selama > 9 bulan. Kesimpulan. HIV merupakan faktor prediktor yang dapat menurunkan keberhasilan terapi TB ekstra paru dengan menggunakan strategi DOTS. Tingkat keberhasilan terapi TB ekstra paru yang menggunakan strategi DOTS selama minimum 9 bulan baik (94,6%).
Kata kunci: TB ekstra paru, faktor prediktor, terapi TB, DOTS.


Background. Extrapulmonary tuberculosis (EPTB) is common presentation found in Indonesia, besides Tuberculosis (TB). We found that no more research about EPTB in Indonesia, especially EPTB success treatment using the DOTS strategy and its predictor factors. Aims. To determine predictors of TB treatment success factors such as age, sex, diabetes mellitus, HIV and anti-tuberculosis records. To acknowledge the success rate of EPTB treatment using DOTS strategy, when administered for a minimum of 9 months. Result. A retrospective cohort study was conducted from 1 January 2008 through 31 December 2012. A total of 542 patients of EPTB were identified, 193 patients were pure EPTB while 279 were mixed ones and 70 were incomplete data. The majority of patients were female (52.3%). Generally young age (18-60 years old (95.9%), mean 31,34 + 11,64 years old. The most common type of EPTB were lymph node. Success treatment rate of EPTB among age of 18-60 years was 49.7% (OR 2.968, 95% CI 0.584 to 15.087, p 0.313). Success treatment rate of EPTB among female sex was 55.4% (OR 1.768, 95% CI 0.999 to 3.131, p0,05). Success treatment rate using DOTS strategy among diabetes mellitus was 33,3% (OR 1.957, 95% CI 0.475-8.062, p 0.546) and the one that had tuberculosis record previously was 55,6% (OR 0.738, 95% CI 0.2781.959, p 0.717) Success treatment rate in extrapulmonary patient among HIV-seropositive was 32,1% (OR 2.588, 95% CI 1.330-5.038, p 0.007). In multivariate analysis, the success rate for EPTB with HIV co-infection factor, had OR 2.588, CI 95% 1.330-5.038, p 0.005. EPTB among HIV-seropositive patients had lower therapy success rate using DOTS strategy and were associated with unsuccessful therapy and poor prognosis. The success rate of EPTB treatment using DOTS strategy for < 9 months was 20.2%. There were 94.6% EPTB patients successfully treated with the DOTS strategy for > 9 months. Conclusion. HIV was a predictor factor that may decrease therapy success rate of EPTB using DOTS strategy. Success rate of extrapulmonary TB treatment using DOTS strategy for minimum 9 months was good (94,6%).
Keywords: Extrapulmonary tuberculosis, Predictors factors, TB treatment, DOTS.