Pathomorphosis of chemoresistant tuberculosis

Objective — to study the profile of the MTB resistance and the results of treatment in patients with pulmonary tuberculosis with different profile of the MTB resistance and a history of previous treatment.Materials and methods. A retrospective cohort study was conducted. The total number of patients included in the study — 1162 patients with multidrug-resistant pulmonary tuberculosis, including pre- and extensively resistance of the MTB, who began treatment on the basis of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine» (Institute) and 9560 — on the basis of KZ «Dnepropetrovsk Regional Clinical Treatment and Prevention Association DOR» during 2006—2017.Results and discussion. Over the last 13 years, there has been a trend towards an increase of primary resistance of fluoroquinolones (including advanced resistance) both according to Institute and Dnipropetrovsk region data: at a minimum frequency in 2006 (0 %) to almost 30,0 % in 2019, against the background of a decrease in the proportion of patients with MDR TB without resistance of fluoroquinolones (from 60,0 to 40,0 %), isoniazid-resistant tuberculosis, rifampicin-resistant tuberculosis and the risks of MDR TB. Un favorable trend — since 2017, the number of patients with MDR and XDR TB has almost equalized. According to the results of treatment in Dnipropetrovsk region, the extremely low efficiency of treatment was maintained from 2009 to 2013 inclusively due «lost to follow-up» — 20,5—26,9 % and «died of other causes» — 9,6—20,5 %, against the background of the same number of «treatment failed» and «died from tuberculosis» from year to year, with the subsequent reduction of the level of separation with the expansion of social support of patients in the outpatient phase of treatment. Immunodeficiency (TB/HIV co-infection) is not the main factor in reducing efficiency: the proportion of HIV deaths has remained unchanged over the past 10 years.Conclusions. All the studied trends are a modern pathomorphosis of tuberculosis in Ukraine, which indicates the urgent need to adopt a new, different from the previous, strategy to combat tuberculosis, which should include: the introduction of completely different regimens of antimycobacterial therapy of short duration and mandatory before treatment.