Pola resistensi kuman Mycobacterium tuberculosis terhadap obat anti tuberkulosis (OAT) di Propinsi Daerah Istimewa Yogyakarta

LESTARI, Setyarini Hestu, Dra. Ning Rintiswati, M.Kes

2003 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang. Tuberculosis (TBC) merupakan penyakit yang masih menjadi masalah kesehatan masyarakat di dunia, termasuk di Indonesia. Untuk memutuskan rantai penularan perlu dilakukan pengobatan penderita dengan Obat anti tuberkulosis (OAT). Pengobatan yang tidak rasional menyebabkan kuman M. tuberculosis resisten terhadap salah satu atau lebih OAT yang digunakan. Resistensi terhadap OAT merupakan masalah terbesar dalam pengobatan dan pemutusan rantai penularan TBC. Penelitian ini bertujuan untuk mengetahui pola resistensi kuman M.tuberculosis terhadap OAT, mengetahui faktor-faktor yang berhubungan dengan resistensi kuman M. tuberculosis terhadap OAT dan konversi dahak pada akhir fase intensif, serta mengetahui hubungan resistensi kuman M tuberculosis terhadap OAT dengan konversi dahak akhir fase intensif. Metode. Penelitian dilakukan di Propinsi DIY, pada bulan Juli s/d Oktober 2002. Subjek penelitian adalah penderita TBC BTA positif pada 2 atau 3 sputum yang berbeda dan berusia di atas 15 tahun yang berobat di Unit Pelayanan Kesehatan. Uji resistensi kuman M tuberculosis terhadap INH, rifampisin, etambutol dan streptomisin dilakukan secara invitro.Pemeriksaan konversi dilakukan pada akhir fase intensif (akhir bulan ke-dua). Faktor berupa status gizi, riwayat penyakit, riwayat kontak dan riwayat pengobatan diukur dengan kuesioner. Analisis statistik dilakukan secara univariat dan bivariat. Hasil. Pola resistensi kuman M. tuberculosis di Propinsi DIY pada bulan Juli s/d Oktober 2002 ditemukan resistensi terhadap INH (61,5%), streptomisin (46,2%) dan etambutol (30,8%). Tidak dijumpai adanya resistensi terhadap rifampisin. Ada hubungan antara resistensi kuman M. tuberculosis terhadap OAT dengan konversi dahak pada akhir fase intensif (p=0,000). Kesimpulan. Resistensi paling banyak dijumpai terhadap INH. Tidak dijumpai adanya MDR. Resistensi berhubungan dengan konversi dahak pada akhir fase intensif.

BACKGROUND Tuberculosis (TB) remains the major public health problem worldwide, including Indonesia. To control the epidemic chain, TB patients need to be treated with antituberculosis drug (OAT). Improper medication leads to the resistance of one or more OAT regimen used for tuberculosis treatment. Resistance to OAT becomes the major problem in the treatment and control of tuberculosis infection chain. This research is aimed to describe the M tuberculosis resistance pattern to OAT, to analyze factors related to the resistance and sputum conversion at the end of the intensive phase, as well as to analyze the relation between M tuberculosis OAT resistance and sputum conversion at the end of the intensive phase. METHODS The study was conducted in Yogyakarta province during the period July - October 2002. Tuberculosis patients over 15 years old with positive acid-fast bacilli (BTA) test in two or more sputum specimen were recruited in the health services. M. tuberculosis resistance test to INK, rifampicin, etambutol and streptomycin were conducted in-vitro. Sputum conversion examination was done at the end of the intensive phase (the end of 2"*^ month of treatment). Factors such as nutritional status, disease history, contact history, and treatment history were identified using questionnaire. Univariate and bivariate statistical analysis were conducted. RESULTS The resistance pattern of M tuberculosis in Yogyakarta Province during July - October 2002 showed 61.3% patient resistance to INK, 46.2% to streptomycin, and 30.9% to etambutol. No resistance to rifampicin was observed. A significant relationship was observed between the M tuberculosis resistance to OAT and sputum conversion at the end of the intensive phase (p=0.000). CONCLUSION The resistance pattern in Yogyakarta was dominated by the resistance ofM tuberculosis to INK. No case of multiple drug resistance was identified in this study. M. tuberculosis resistance to OAT was significantly related to the sputum conversion at the end of the intensive phase. KEYWORDS Tuberculosis - anti-tuberculosis drugs - resistance - sputum conversion - risk factors

Kata Kunci : Epidemiologi,Resistensi Kuman MT,Obat Anti Tuberkulosis