Transcript Slide 1
qeTevan barbaqaZe tfdec. 20 aprili. 2010 weli. 1. swrafi gavrceleba; 2. aiv-is koinfeqcia; 3. wamlebis mimarT rezistentoba. • daudevroba “SemTxvevis marTvaSi”; • jandacvis sistemis cudi funqcionireba; • SeZenili rezistentobiT ganpirobebuli “insidentoba” •Kmkurnalobis araswori reJimebi • medikamentebis cudi xarisxi M • medikamentebiT wyvetili momarageba P • pacientis cudi damyoloba • infeqciis cudi kontroli • XDR-TB- is gavrcelebis Seswavla • baqteriologiuri laboratoriis gafarToeba, teqnikuri uzrunvelyofa • infeqciis kontrolis danergva • intensiuri kvlevebi axali medikamentebis Sesaqmnelad • diagnostikis swrafi meTodebi • arT-Terapiis xelmisawvdomoba • I da II rigis medikamentebis gamoyenebaze kontrolis daweseba. • kvlevaSi monawileobda tuberkuloziT daavadebuli 810 pacienti • 651 av-s mkurnalobis dawyebamde daudgindaT rezistentoba • XDR-TB - 48 pacienti (7,4%) • MDR-TB - 603 pacienti (92,6%) A • aiv-koinfeqcia: XDR-TB - 0 pacienti MDR-TB – 9 (1,5%) pacienti • 7 pacienti mokvda mkurnalobis dawyebamde, maTgan 1 - XDR-TB • XDR-TB - 4,2±1,9 p<0,001 • MDR-TB - 3,2±1,6 Tveebis mixedviT •XDR-TB - 34,7±23,7 • MDR-TB – 25,1±16,6 p<0,001 • ambulatoriul reJimSi • yoveldRe • kontrolis qveS (DOT) • gverdiTi movlenebis marTvas • qirurgiul Carevas • sakvebiT da fsiqo-socialur daxmarebas • sqema Sedgeboda sul mcire 5 savaraudod efeqturi medikamentisgan, ftorqinolonisa da saineqcio medikamentis CaTvliT; • sqemaSi Sedioda I rigis preparatebi, romlebic adre iyvnen gamoyenebulni, magram in vitro sensitioba dadginda; • damatebiTi medikamentebi: klaritromicini, amoqsacilin-klavulanis mJava, klofazimini, rifabutini • saineqcio medikamentis gamoyenebis xangrZlivobis gazrdiT an • mkurnalobis xangrZlivobis gazrdiT da/an sxva medikamentis damatebiT • sul mcire 18 Tve peroraluri medikamentebisTvis K • sul mcire 8 Tve kulturis konversiidan saineqcio medikamentebisTvis •Qsul mcire 18 Tve qirurgiuli Carevis Semdeg • yovelTviurad naxvelis nacxi da kultura • SesaZlebeli iyo hospitalizacia saTanado CvenebiT, qirurgiis CaTvliT • 4 Tvis mkurnalobis Semdeg kulturis konversiis ararsebobisas – ganmeorebiTi DST • gverdiTi movlenebis agresiuli mkurnaloba standartuli sqemebiT - mkurnalobis manZilze samedicino CvenebiT, qirurgiis CaTvliT, hospitalizebuli iyo 11 XDR pacienti, saSualod 14 dRis ganmavlobaSi, intervali 5-54 dRe - qirurgiuli Careva, rogorc damatebiTi mkurnaloba, Cautarda: 7 XDR pacients (14,6%) 87 MDR pacients (14,4%) • XDR-TB pacientebSi - 90 dRe • MDR-TB pacientebSi – 61 dRe • XDR-TB – 29 (60,4%) SemTxveva • MDR-TB - 400 (66,3%) SemTxveva •XDR-TB – 2 (6,9%) SemTxveva p - 0,40 • MDR-TB - 15 (3,8%) SemTxveva meTvalyureobis saSualo vada mkurnalobis damTavrebis Semdeg – 19, 4 Tve. intervali - 10, 7 - 27, 0 Tve • programis agresiuli, zustad Sesatyvisi menejmentiT SesaZlebelia XDR-TB pacientebis 60% -ze metis gankurneba •Kkulturis konversiam XDR-TB pacientebSi 1 TviT daigviana • “relafsisa” da sikvdilis riski mniSvnelovnad ar gansxvavdeboda erTmaneTisagan. •Aagresiuli reJimebi: bevri medikamenti da yvelaze maRaltolerantuli dozebi • Zalian xangrZlivi mkurnaloba. umravles SemTxvevaSi > 2 welze • DST profilze damyarebuli samkurnalo reJimebis Ddizaini – 5 savaraudod efeqturi medikamenti • samkurnalo reJimebi aucileblad Seicavda: Cm, PAS, Cs –s • saineqcio preparatis gamoyenebis xangrZlivoba TiTqmis 15 Tve • Mfx da Lfx-is gamoyeneba, Tu izolanti rezistentuli iyo Cfx-ze • aucileblobisas E da Z –s gamoyenebiT reJimis gaZliereba Tu maT mimarT rezistentoba iyo araerTgvarovani • reJimebis gaZliereba Amx/clv, Cfz, Clr, Rifabutin-iT • rezistentobis maRali xarisxiT L • lokaluri dazianebiT da “sawyisi uSedegobiT” • XDR-TB pacientebTan cudi gamosavali nakleb xSiri iyo - 28, 6 %, vidre yvela danarCenSi- 39, 6 % •Bbaqteriologiuri Sefaseba strategiis ganuyofeli nawili iyo • yovelTviurma monitorirebam adreul etapze gamoavlina avadmyofebi, romlebic ar eqvemdebarebodnen mkurnalobas • ganmeorebiTi DST me- 4 Tvis bolos mkurnalobis gaZlierebis saSualebas iZleoda •Gganapiroba damyolobis maRali xarisxi • gverdiTi movlenebis agresiuli marTva •Ffsiqo-socialur moTxovnebze sxvadasxva xarisxis intervencia • XDR-TB – is SemTxvevebis naxevarze meti ganikurna, miuxedavad SezRuduli resursebisa da warsulSi mravaljeradi qimioTerapiisa •Aaucilebelia sxva intervenciebis gatareba, raTa gaumjobesdes mkurnalobis gamosavali. • aSkaraa, rom axali wamlebi, vaqcinebi da diagnostikuri saSualebebi dauyovnebliv ar iqneba • ar arsebobs jadosnuri tyvia XDR-TB – is problemis mosakvdineblad • tuberkulozis kontrolis sust programebs zianis motana ufro SeuZliaT, vidre sargeblis – mravldeba MDR-TB – isa da XDR-TB – is SemTxvevebi XDR-TB – is safrTxe unda iyos stimuli tuberkulozis kontrolis sabaziso principebis gasaZliereblad