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The Situation of Multidrug-Resistant Tuberculosis in Turkey Dr. Serir Aktoğu Özkan

The Situation of Multidrug-Resistant Tuberculosis in Turkey Dr. Serir Aktoğu Özkan Izmir Training Hospital for Thoracic Diseases and Surgery. Contributors. Dr. Kemal Tahaoğlu Dr. Turan Karagöz Dr. Şeref Özkara Dr. Haluk Celalettin Çalışır Dr. Emel Çağlar Dr. Özlen Tümer Dr. Seren Arpaz

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The Situation of Multidrug-Resistant Tuberculosis in Turkey Dr. Serir Aktoğu Özkan

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

  2. Contributors • Dr. Kemal Tahaoğlu • Dr. Turan Karagöz • Dr. Şeref Özkara • Dr. Haluk Celalettin Çalışır • Dr. Emel Çağlar • Dr. Özlen Tümer • Dr. Seren Arpaz • Dr. Tülay Törün • Dr. Gönenç Ortaköylü • Dr. Onur Fevzi Erer

  3. Drug Resistance in Istanbul No drug resistance survey in Turkey Results from Central Laboratory of Istanbul Society Against Tuberculosis ,1999 6.1 Z.Kılıçaslan Eur J Clin Microbiol Infect Dis ,2002

  4. Primaryand 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

  5. The Multidrug resistance rates in Izmir Chest Diseases Hospital G. Şenol Journal of Infection 2005; 50: 306-11

  6. Several studies reporting MDR TB rates in Turkey

  7. Süreyyapaşa Chest Diseases Hospital January- December 2004 • Totally 530 TB Patients • Sputum culture positive 333 patients • 39 (11.7 %) patients with MDR (HR resistance) Dr. Haluk Celalettin Çalışır Toraks 2006

  8. 4 Centers for MDR-TB in Turkey

  9. 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. Şeref Özkara

  10. 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

  11. Treatment results of 61 patients with MDR-TB in Izmir Chest Diseases Hospital

  12. Treatment resultsof MDR-TB 1998-2005 Nazilli Dispensary Aydın Dispensary Dr. Seren Arpaz

  13. Marmara Sea ISTANBUL Population: 12-15 million Poverty, migration, inequality, insufficient infrastructure 2 centers for TB

  14. 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 Çağlar, Dr. Gönenç Ortaköylü

  15. Characteristics of patients with MDR-TB in Yedikule Chest Diseases Hospital (2001-2005) N= 178 Dr. Emel Çağlar, Dr. Gönenç Ortaköylü

  16. Characteristics of patients with MDR-TB in Yedikule Chest Diseases Hospital (2001-2005) N= 178 Dr. Emel Çağlar, Dr. Gönenç Ortaköylü

  17. Süreyyapaşa 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

  18. Süreyyapaşa Chest Diseases Hospital1992 – 2004 MDR-TB “The Treatment of MDR-TB in Turkey” K. Tahaoğlu et al. N Eng J Med, 2001

  19. Süreyyapaşa Chest Diseases Hospital1992 – 2004 MDR-TB K. Tahaoğlu et al. N Eng J Med, 2001

  20. Süreyyapaşa Chest Diseases Hospital1992 – 2004 MDR-TBTreatment Results K. Tahaoğlu et al. N Eng J Med, 2001

  21. Süreyyapaşa Chest Diseases Hospital1994 – 2000 MDR-TB Dr. Turan Karagöz

  22. Süreyyapaşa Chest Diseases Hospital1994 – 2000 MDR-TB Dr. Turan Karagöz

  23. Süreyyapaşa Chest Diseases Hospital1994 – 2000 MDR-TB Dr. Turan Karagöz

  24. Süreyyapaşa Chest Diseases Hospital2000- 2004 MDR-TB 238 Dr. Turan Karagöz

  25. Süreyyapaşa Chest Diseases Hospital ,2000- 2004 MDR-TB Treatment Results %70 %6 %13 %11 Dr. Turan Karagöz

  26. Heybeliada Göğüs Hastalıkları ve Göğüs Cerrahi Merkezi E.A.H.

  27. 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+ protionamide+cycloserine+PAS Dr.M.Kurutepe,A.Saygı,A.Hazar,G.Yurteri

  28. Treatment results of 228 patients with MDR-TB in Heybeliada Chest Hospital, Istanbul 2 cases relapsed after cure

  29. 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

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