Role of surgery in multi-drug-resistant tuberculosis: results of 27 cases.

OBJECTIVE: To evaluate the results of resectional surgery as an adjuvant therapy in multi-drug resistant tuberculosis. METHODS: A total of 27 human immunodeficiency virus (HIV)-negative patients with multi-drug resistant tuberculosis underwent resectional surgery between 1993 and 1996. The lesions were bilateral in 16 cases, with a preponderance of cavities on one side. Out of 27 cases, 5 patients had unilaterally destroyed lung; 20 patients underwent pneumonectomy (15 left, 5 right). Lobectomy operations included bilobectomy superior (n = 1), right lower lobectomy (n = 2), right upper lobectomy (n = 3), and left upper lobectomy with superior segmentectomy (n = 1). RESULTS: Because of haemorrhage, 2 cases who underwent a right and left pneumonectomy, respectively, required revision on the first day . Bronchopleural fistula was found in 2 cases with left pneumonectomy. Apical residual space was left in one of the 3 patients who underwent right upper lobectomy. Retreatment protocols resulted in negative cultures and smears in all patients with an average duration of 4 months (1-6 months). A total of 4 patients (16%) completed a retreatment period of 18-24 months with negative cultures. Only 1 patient (3.7%) developed relapse in the 17th month of retreatment. Patients with negative cultures numbered 22 and continued receiving retreatment. CONCLUSIONS: Our results indicate that surgical management of multi-drug resistant tuberculosis, combined with chemotherapy, provides a more favourable outcome than that obtained with medical therapy alone.

Alarming drug-resistance rates for tuberculosis in Süreyyapasa Hospital, Turkey.

The susceptibility patterns to 'classic' tuberculous pleuritis can reflect the circulating strains in a society. The records of patients with 'classic' tuberculous pleuritis were reviewed retrospectively. Eighty-six patients were selected who were hospitalized between January 1990 and April 1994. Pleural fluid and tissue samples of patients were cultured in Lowenstein-Jensen medium. The isolated strains were subjected to drug susceptibility testing based on the absolute concentration method. We obtained 40 positive cultures in 86 patients with 'classic' tuberculous pleuritis. The resistance rate was 75% to one or more drugs, 27.5% to two drugs, 15% to three drugs, and 10% to four drugs. The resistance rates to isoniazid, rifampicin, streptomycin, and ethambutol were 32.5, 55,42.5 and 32.5%, respectively. The resistance to isoniazid + rifampicin was 7.5%. Our findings indicate that the resistance rates for 'classic' tuberculous pleuritis are considerably high, reflecting the currently circulating resistance patterns in our region. The best regimen for new tuberculous cases and the appropriate regimens for drug-resistant cases should be designed and conducted by a nationwide institution.