Ways to improve the effectiveness of treatment of patients with destructive pulmonary tuberculosis with multiple and broad drug resistance of the pathogen

Abstract

SummaryTreatment of patients with destructive forms of drug-resistant pulmonary tuberculosis remains a difficult problem. The presence of a destruction cavity in the lung reduces the effectiveness of therapy and is a negative prognostic factor. The objective of the study: to search for the optimal tactics for the treatment of destructive drug-resistant pulmonary tuberculosis and to evaluate the impact of collapsing procedures and surgical interventions on the outcome of treatment according to immediate and long-term observations. Materials and methods. The study included 398 patients with destruc-tive pulmonary tuberculosis with registered multiple (MDR-TB) in 61.3% and extensively drug-resistant (XDR-TB) in 38.7% of patients. Depending on the treat-ment tactics chosen in the clinic, 2 groups of patients were formed who received individualized chemothera-py based on the results of drug susceptibility testing of the pathogen and were comparable in other significant evaluation criteria. The main group consisted of 269 pa-tients, whose management tactics included the staged use of invasive methods of treatment, the comparison group — 129 patients who received only adequately selected anti-tuberculosis chemotherapy due to the im-possibility of using invasive methods. Staged invasive treatment included collapsotherapeutic techniques used in the absence of regression of the tuberculosis process against the background of adequately selected chemo-therapy for 1.5–2 months, and, if the previous stage was ineffective, resection surgery 4–6 months after the start of treatment in the clinic. Results: In the main group, collapse therapy procedures were performed in 179/269 (66.5%) patients, and they were successful in 106/115 (92.2%) patients with MDR-TB and in 51/64 (79.7%) pa-tients with XDR TB (p=0.44). Surgical interventions were performed in 25/269 (9.3%) patients, which were effec-tive in 20/25 (80%). Postoperative complications were registered in 4/25 (16%) patients. In general, microbiolog-ical conversion of sputum and closure of decay cavities were registered in 245/269 (91.1%) patients of the main group and in 75 out of 129 (58.6%) of the comparison group. Conclusion. Timely correction of treatment tac-tics based on the staged application of collapse therapy and surgical methods made it possible to achieve a cure in 91.1% of previously ineffectively treated patients with destructive pulmonary MDR/XDR tuberculosis.