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Resistensi Mikobakterium Tuberkulosis Terhadap Obat Antituberkulosis Pada Penderita Meningitis Tuberkulosi Definit

Resistensi Mikobakterium Tuberkulosis Terhadap Obat Antituberkulosis Pada Penderita Meningitis Tuberkulosi Definit
Dedeh Supartini, Dede Gunawan, Nurdjaman Nurimaba, Sri Aminah, Fransisca Srioetami
Unpad
Indonesia
Unpad
,

Latar belakang dan tujuan: Terjadi peningkatan kejadian resistensi obat antituberkulosis, bahkan disebut sebagai Epidemi Multidrug Resistance Tuberculosis (MDR-TB). Angka kejadian tuberculosis (MTB) tidak diketahui dan belum pernah diteliti. Oleh karena itu dilakukan penelitian mengenai resistensi obat antituberkulosis (OAT) pada pendenta MTB definit ( Kultur Positif ). Metode: Rancangan penelitian selective prevelance design dari data primer probable Meningitis Tuberkulosis menurut kriteria Ogawa. Terhadap subjek dilakukan punksi lumbal yang tidak traumatik dengan masa penyimpanan kurang dan 48 jam setelah punksi. Kemudian dibuat kultur mikobakterium. Bila positif (+) diuji kepekaan invitro terhadap 6 jenis Obat Antituberkulosis (OAT) yaitu Rifampisin, INH, Etambutol, Pirazinamid, Streptomisin dan Kanamisin. Selanjutnya diuji dengan tehnik Mann Whitney serta uji Fischer dengan kemaknaan P=0.05. Hasil: Kultur positif pada 29 kasus (62%). Diantaranya 15 resisten ( 11 kasus resisten 1 OAT, 4 kasus resisten terhadap 2 OAT, tidak ada kasus dengan resisten terhadap lebih 2 OAT, dan tidak ditemukan kasus MDR -TB). Terbanyak kasus dengan resisten Etambutol ( 6 kasus ). Kesimpulan: bersadarkan kriteria probable M-Tb menurut Ogawa diperoleh 62 kasus yang terbukti secara bakteriologis. 15 kasus temyata resisten terhadap paling sedikit satu OAT. Tidak ditemukan kasus dengan MDR-Tb.

Background and purpose: the incidence of drug resistant tuberculosis has increased recently, and there were outbreaks of Multidrug-resistant tuberculosis (MDR-TB) around the world. The incidence of MDR in tuberculous meningitis (TBM) was ur-known and there was no study about it before this study. In this study we attemped to reveal antituberculous-drug-resistant in cases with definite (culture-proved) TBM. Subjects and Methods: A selective prevalence design study was performed of all cases with probable TBM (Ogawa criteria). Non-traumatic lumbar puncture was performed. Available cerebrospinal fluid (which stored less than 48 hours after the puncture) were cultured in medium for mycobacterium. To the positive (+) culture we performed in-vitro drug-susceptibility test against 6 antituberculous drugs (ATDs): Rifampycin, INH, Ethambutol, Pyrazinamid, Streptomycin and Kanamycin. Statistical analysis was done with Mann Whitney and Fischer test. Statistical significance was set at P=0.05. Results: TB culture was positive for 29 cases (62%). 15 of them were resistant ( 11 cases resistant to 1 ATD, 4 cases resistant to 2 ATDs, no cases with resistancy to more than 2 ATDs, no cases of MDR-TB). 6 cases were resistant to ethambutol. Conclusions : Based on the criteria of probable TB (Ogawa) we revealed 62 cases confirmed bacteriologically. 15 of them resistant to at least one ATD. No cases with MDR-TB.

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