Tesis

Perbandingan Waktu Konversi Biakan Dahak Pasien Tuberkulosis Resistan Obat dengan Pengobatan Paduan Jangka Pendek dan Individual = Differences in Time to Sputum Culture Conversion Between Drug-resistant Tuberculosis Patients Treated with Short-term Regimen and Individualized Regimen.

Latar belakang dan tujuan : Indonesia merupakan satu dari 30 negara di dunia dengan beban tuberkulosis resistan obat (TB RO) terbanyak di dunia. Sejak Mei 2016, World Health Organization (WHO) telah merekomendasikan pemakaian paduan jangka pendek 9-11 bulan untuk pasien yang memenuhi kriteria. Studi observasional dari beberapa negara di Asia dan Afrika menunjukkan angka keberhasilan pengobatan yang lebih baik pada paduan jangka pendek dibandingkan paduan individual. Waktu konversi biakan dahak digunakan sebagai prediktor awal untuk menilai keberhasilan pengobatan. Penelitian ini dilakukan untuk mengetahui perbedaan waktu konversi biakan dahak antara pengobatan paduan jangka pendek dengan individual. Metode : Penelitian ini merupakan studi kohort observasional dengan consecutive sampling yang dilakukan pada bulan Agustus 2019 sampai September 2020 di RSUP Persahabatan, Jakarta. Subjek adalah pasien TB RO yang terkonfirmasi dengan tes cepat molekular. Subjek yang memenuhi syarat menggunakan paduan jangka pendek sesuai kriteria kementrian kesehatan Indonesia akan mendapatkan paduan jangka pendek. Subjek yang tidak memenuhi kriteria akan mendapatkan paduan individual. Biakan dahak dikerjakan dengan menggunakan media cair Mycobacterial Indicator Tube (MGIT). Dahak dianggap konversi jika pemeriksaan biakan dahak dua kali berurutan dengan jarak pemeriksaan 30 hari menunjukkan hasil negatif. Hasil : Subjek penelitian yang memenuhi kriteria inklusi adalah 195 orang. Subjek yang mendapat paduan jangka pendek berjumlah 63 orang sedangkan subjek yang mendapat paduan individual berjumlah 132 orang. Pada paduan jangka pendek, subjek yang mengalami konversi biakan dahak adalah 38 orang (60,3%) sedangkan paduan individual 85 orang (64,4%). Median waktu konversi biakan dahak pada paduan jangka pendek 36 hari (IK 95% 30,5-41,5) sedangkan paduan individual 64 hari (IK 95% 61,5-66,5) dengan nilai p 0,001. Faktor yang mempercepat waktu konversi adalah tanpa komorbid DM (HR 2,3; [IK 95% 1,475-3,678]), bacterial load BTA 2+ (0,4;[0,159-0,810]), BTA 1+ (0,5;[0,2520,899]), BTA scanty (0,5;[0,300-0,758]), BTA negatif (0,5;[0,309-0,896]), pola resistansi MDR (0,4;[0,193-0,667]), poliresistan (0,6;[0,423-0,958]). Kesimpulan : Waktu konversi biakan dahak pada paduan jangka pendek dan paduan individual berbeda bermakna namun jenis paduan tidak mempengaruhi lama konversi.
Kata Kunci : konversi biakan dahak, paduan jangka pendek, paduan individual, TB RO


Background: Indonesia is one of countries with the highest drug-resistant tuberculosis (DR-TB) burden in the world. Since May 2016, World Health Organization (WHO) has recommended the use of short-term regimen (nine to eleven months) for DR-TB. Based on observational studies from several Asian and African countries, the short-term regimen had better success rate than the individualized regimen (twenty to twenty four months). Time to sputum culture conversion is used to predict the final treatment outcome. This study aims to identify the differences in time to sputum culture conversion between short-term regimen and individualized regimen in DR-TB. Methods: An observational cohort study was conducted on August 2019 to September 2020 at Persahabatan Hospital, Jakarta, Indonesia. Subjects were DRTB patients eligible for the shorter regimen based on Ministry of Health Republic Indonesia criteria; other than those subjects had been given the individualized regimen. Sputum culture was done using Mycobacterial Indicator Tube (MGIT) method. Sputum cultures conversion were considered when two consecutive cultures, taken at least thirty days apart, were negative. Results: In this study, 195 subjects met the inclusion criteria; 63 subjects received short-term regimen and 132 subjects received individualized regimen. Sputum culture conversion in short-term regimen group were found in 38 people (60.3%) and in individualized regimen were found in 85 people (64.4%). The median time of sputum culture conversion in short-term regimen were 36 days (95% CI 30.541.5) while the individual regimen were 64 days (95% CI 61.5-66.5) (p=0.002). Factors that accelerated the conversion time were without diabetes mellitus (HR 2.3; [95% CI 1.475-3.678]), AFB stain of +2 (0.4; [0.159-0.810]), AFB stain of +1 (0.5; [0.252-0.899]), scanty AFB stain (0.5; [0.300-0.758]), negative AFB stain (0.5; [0.309-0.896]), resistance pattern of MDR (0.4; [0.193-0.667]), and resistance pattern of poly-drug-resistance (0.6; [0.423-0.958]). Conclusion: Time to sputum culture conversion, but not the duration of the conversion, in short-term regimen and individualized regimen was significantly different.
Keywords: DR-TB, individualized regimen, short-term regimen, sputum culture conversion