Slayt 1

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The Situation of Multidrug-Resistant Tuberculosis
in Turkey Dr. Serir Aktogu Özkan Izmir Training
Hospital for Thoracic Diseases and Surgery
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Contributors

• Dr. Kemal Tahaoglu
• Dr. Turan Karagöz
• Dr. Seref Özkara
• Dr. Haluk Celalettin Çalisir
• Dr. Emel Çaglar
• Dr. Özlen Tümer
• Dr. Seren Arpaz
• Dr. Tülay Törün
• Dr. Gönenç Ortaköylü
• Dr. Onur Fevzi Erer

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Drug Resistance in Istanbul

• No drug resistance survey in Turkey
• Results from Central Laboratory of Istanbul
  Society Against Tuberculosis ,1999

New Cases Old cases
Resist. to at least one drug 209 19.9 131 40.4
MDR 33 3.1 60 18.5
Total 1046 100 324 100
6.1
Z.Kiliçaslan Eur J Clin Microbiol Infect Dis ,2002
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Primary and Secondary MDR-TB in Istanbul,
1990-2004
(1) (2)
(3)
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
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The Multidrug resistance rates in Izmir Chest
Diseases Hospital
1999 2001
No of patients No of cultures 980 11 132 1006 11 069
Culture () samples 420 653
MDR TB 65 (6.6) 58 (5.8)
G. Senol Journal of Infection 2005 50 306-11
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Several studies reporting MDR TB rates in Turkey
Date Author/ Localization Patient No MDR TB New Old Total
1972-1999 Kart et al Zonguldak Kayseri 3718 6.9 107
1976-1997 Bengisun Ankara 3319 5.8 194
1999-2001 Güneri Izmir 474 4.4 17.2 6.8 17 15 32
1997-2003 Sürücüoglu Manisa 355 4.4 22.4 7.3 26
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Süreyyapasa Chest Diseases Hospital January-
December 2004

• Totally 530 TB Patients
• Sputum culture positive 333 patients
• 39 (11.7 ) patients with MDR (HR resistance)

Cured Default Failed Died Total
New 18 0 0 1 19
Old 10 2 8 0 20
Dr. Haluk Celalettin Çalisir
Toraks 2006
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4 Centers for MDR-TB in Turkey
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Atatürk Chest Diseases Hospital

• Bed number 550
• TB bed number 150
• Number of hospitalized TB patients /year
  1500
• The treatment of MDR-TB has been done since 1991
• Drug susceptibilty test can be done in every
  patient
• After evaluating for compliance, the patients are
  treated with minör anti tb drugs
• There is no data regarding treatment results
• 
  
  Dr. Seref Özkara

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Izmir Chest Diseases Hospital

• Bed number 450 (2005)
• TB bed number 78
• Number of hospitalized patient 16 884
• Number of hospitalized TB patient 770
• The treatment of MDR-TB has been done since 1998
• 270 patients with MDR TB were treated until
  December 2005

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Treatment results of 61 patients with MDR-TB in
Izmir Chest Diseases Hospital
Patient No
Cured 22 36
Completed 9 15
Default 9 15
Failed 1
Died 13 21
Transferred 2
Lost at followup 5
Total 61
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Treatment results of MDR-TB 1998-2005
Nazilli Dispensary
Case number DOT() DOT(-)
Cured 6 75 3 3
Died 2 25 1 1
treatment 2 2
Aydin Dispensary
Cured 3 100 3
treatment
Dr. Seren Arpaz
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Marmara Sea
ISTANBUL
Population 12-15 million Poverty, migration,
inequality, insufficient infrastructure 2 centers
for TB
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Yedikule Chest Diseases HospitalMDR-TB 2001-2005

• Bed number
  408 (2005)
• Number of hospitalized patient 10 533 (2005)
• Number of hospitalized TB patient 1 697 (2005)
• Mean hospitalization time of TB patients 23
  days
• MDR-TB patients were treated related to the
  orders of The Committee of Resistance since 2001
• Treatment results of 178 patients with MDR-TB are
  available in the period of 2001-2005
• Dr. Emel Çaglar, Dr. Gönenç Ortaköylü

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Characteristics of patients with MDR-TB in
Yedikule Chest Diseases Hospital (2001-2005) N
178
Age 38 (17-66)
Sex (Male/Female) 166/12
Median no. of drugs previously used 4.6
Median no. of resistant drug 3.1
Median no. of drugs used in study regimen 5.9
Surgery 19 (10)
Median hospitalization 71.8 day
Dr. Emel Çaglar, Dr. Gönenç Ortaköylü
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Characteristics of patients with MDR-TB in
Yedikule Chest Diseases Hospital (2001-2005) N
178
Treatment success 116 (65.2)
Cured 68 (38.2)
Probable cured 48 (27)
Failed 9 (5.1)
Default 16 (9)
Transferred 3 (1.7)
Died 16 (9)
Dr. Emel Çaglar, Dr. Gönenç Ortaköylü
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Süreyyapasa Chest Diseases Hospital

• Bed number
  1020
• Number of hospitalized patients /year 16
  000
• Number of hospitalized TB patients /year 2
  500
• Treatment of MDR-TB has been done since 1992
• Second-line drugs have been provided by Social
  Security System
• The patients with MDR-TB could be hospitalized
  for long period and default rate was low

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Süreyyapasa Chest Diseases Hospital 1992 2004
MDR-TB
No of patients 252
Age (yr) 37.9 (14 - 68)
Sex Male Female 204 (81) 48 (19)
Duration of disease (mo) 75.6 (0-416)
Primary resistance Secondary resistance 60 (23.8) 192 (76.2)
The Treatment of MDR-TB in Turkey K. Tahaoglu
et al. N Eng J Med, 2001
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Süreyyapasa Chest Diseases Hospital 1992 2004
MDR-TB
Drug resistance 4.1 (4 - 9)
Median no of drugs used in study regimen 5.4 (3 9)
Median no of active drugs 4.5 (1 8)
The mean duration of hospitalization (day) 179 (30 - 450)
Surgery 66 (26.2)
K. Tahaoglu et al. N Eng J Med, 2001
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Süreyyapasa Chest Diseases Hospital 1992 2004
MDR-TBTreatment Results
Cured 176 (70)
Probable cured 17 (7)
Failed 16 (6)
Died 18 (7)
Default 25 (10)
Relapse 3 (1)
K. Tahaoglu et al. N Eng J Med, 2001
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Süreyyapasa Chest Diseases Hospital 1994 2000
MDR-TB
No of patients 142
Age 8yr) 39 (16 - 65)
Sex Male 142
Duration of disease (mo) 93.6(1-420)
Primary resistance Secondary resistance 21 (15) 12 (85)
Dr. Turan Karagöz
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Süreyyapasa Chest Diseases Hospital 1994 2000
MDR-TB
Drug resistance 3.8 (2 - 7)
Median no of drugs used in study regimen 5.4 (3 8)
The mean duration of hospitalization (day) 261(68- 978)
Surgery 34 (24)
Dr. Turan Karagöz
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Süreyyapasa Chest Diseases Hospital 1994 2000
MDR-TB
Cured 99 (70)
Failed 9 (6)
Died 19 (13)
Default 15 (11)
Relapse -
Dr. Turan Karagöz
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Süreyyapasa Chest Diseases Hospital 2000- 2004
MDR-TB
238
No of patients 96
Age (yr) 40 (14 - 66)
Sex Male Female 77 (80.3) 19 (19.7)
Primary resistance Secondary resistance 42 (56.3) 54 (43.7)
Dr. Turan Karagöz
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Süreyyapasa Chest Diseases Hospital ,2000- 2004
MDR-TB Treatment Results
70
Cured 88 (92)
Probable cured -
Failed 4 (4)
Died 3 (3)
Default 1 (1)
6
13
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Dr. Turan Karagöz
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Heybeliada Gögüs Hastaliklari ve Gögüs Cerrahi
Merkezi E.A.H.
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Heybeliada Chest Diseases Hospital

• 297 patients with MDR-TB was treated related to
  the orders of The Committee of Resistance between
  December 1996-December 2004. Treatment was
  completed in 228 patients. Surgery was done in 46
  patients.
• Diagnosis was based on BACTEC method and
  susceptibility tests.
• At least five new drugs were used
• Aminoglycoside(minumum 6 mo) quinolones
  protionamidecycloserinePAS

Dr.M.Kurutepe,A.Saygi,A.Hazar,G.Yurteri
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Treatment results of 228 patients with MDR-TB in
Heybeliada Chest Hospital, Istanbul
Total
Cured 154 68
Failed 5 2
Default 60 26
Death 9 4
Total 228 100
2 cases relapsed after cure
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Last Comments

• Insufficient registry and reporting system
• There are a lot of problems in terms of diagnosis
  of MDR-TB (over diagnosis or insufficient
  diagnosis)
• There are a lot of problems in management of
  patients with MDR-TB
• Therapy is not directly observed
• Insufficient using bacteriologic methods during
  followup
• Cure rates are low in some centers
• There is potential to solve this problem in Turkey