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master's thesis
Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj
Zagreb: University of Zagreb, School of Medicine, 2020. urn:nbn:hr:105:742861
Šklebar, Tomislav
University of Zagreb
School of Medicine
Department of Internal Medicine

Institutional repository: Dr Med - University of Zagreb School of Medicine Digital Repository

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Šklebar, T. (2020). Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj (Master's thesis). Zagreb: University of Zagreb, School of Medicine. Retrieved from https://urn.nsk.hr/urn:nbn:hr:105:742861

Šklebar, Tomislav. "Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj." Master's thesis, University of Zagreb, School of Medicine, 2020. https://urn.nsk.hr/urn:nbn:hr:105:742861

Šklebar, Tomislav. "Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj." Master's thesis, University of Zagreb, School of Medicine, 2020. https://urn.nsk.hr/urn:nbn:hr:105:742861

Šklebar, T. (2020). 'Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj', Master's thesis, University of Zagreb, School of Medicine, accessed 23 April 2024, https://urn.nsk.hr/urn:nbn:hr:105:742861

Šklebar T. Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj [Master's thesis]. Zagreb: University of Zagreb, School of Medicine; 2020 [cited 2024 April 23] Available at: https://urn.nsk.hr/urn:nbn:hr:105:742861

T. Šklebar, "Ishodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj", Master's thesis, University of Zagreb, School of Medicine, Zagreb, 2020. Available at: https://urn.nsk.hr/urn:nbn:hr:105:742861

Metadata
TitleIshodi liječenja i petogodišnje preživljenje bolesnika s plućnim netuberkuloznim mikobakteriozama u Hrvatskoj
Title (english)Treatment outcomes and five-year survival of patients with nontuberculous mycobacterial pulmonary disease in Croatia
AuthorTomislav Šklebar
MentorMateja Janković Makek (mentor)
Committee memberGordana Pavliša (predsjednik povjerenstva)
Committee memberJasenka Markeljević (član povjerenstva)
Committee memberMateja Janković Makek (član povjerenstva)
GranterUniversity of Zagreb
School of Medicine
(Department of Internal Medicine)
Zagreb
Defense date and country2020-07-17, Croatia
Scientific / art field,
discipline and subdiscipline		BIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Internal Medicine
Abstract
Plućne manifestacije netuberkuloznih mikobakterijskih infekcija (NTM-PD) najčešći su oblik bolesti i sve se više prepoznaju kao važan klinički entitet u ljudi. Najčešće zahvaćaju stariju populaciju s predležećim kroničnim plućnim bolestima. Cilj ove studije bio je utvrditi karakteristike bolesnika s NTM-PD u Hrvatskoj te zabilježiti kliničke ishode i dugoročno preživljavanje nakon završetka terapije. Ovaj stručni rad predstavlja retrospektivnu kohortnu studiju na svim hrvatskim stanovnicima s NTM izoliranim iz respiratornih uzoraka u razdoblju od 1. siječnja 2006. do 31. prosinca 2015. i praćenjem do 31. prosinca 2018. Podaci analizirani u ovoj studiji predstavljaju centralizirane podatke Nacionalnoga registra bolesnika s izoliranim NTM koji se od 2008. godine vodi u Nacionalnome referentnome laboratoriju za mikobakterije (NRML) pri Hrvatskom zavodu za javno zdravstvo (HZJZ), a sadrži kliničke, radiološke te podatke o ishodu liječenja i datum smrti. Tijekom promatranoga razdoblja, u registru je identificirano ukupno 2109 epizoda plućnih NTM izolata kod 2050 bolesnika. Kriteriji za definitivnu bolest zadovoljilo je 137 (29,3%), a bez bolesti 302 (64,3%) od ukupno 468 epizoda s potpunom medicinskom dokumentacijom. Preostalih je 29 (6,2%) epizoda klasificirano kao vjerojatna bolest. Medijan dobi bolesnika s definitivnom NTM plućnom bolesti iznosio je 66,5 (16-90) godina. Od ukupnoga broja bolesnika u ovoj skupini, 62 (45,3%) bolesnika su bile žene. Najčešći komorbiditet u 44,5% bolesnika bila je kronična opstruktivna plućna bolest. Mikrobiološko izlječenje postignuto je u 82,8% bolesnika nakon adekvatnoga NTM liječenja, u 64,7% bolesnika liječenih TB protokolom, te u 64,3% bolesnika liječenih kratkim NTM protokolom, a spontana konverzija kulture u 41,2% neliječenih bolesnika. U Hrvatskoj NTM plućnu bolest najčešće uzrokuje M. xenopi i MAC s ukupnim 5- godišnjom smrtnošću od 36.5%. Terapija prema smjernicama rezultirala je četiri puta većom vjerojatnošću izlječenja u usporedbi s neadekvatno liječenima ili neliječenim bolesnicima. Ishodi liječenja razlikuju se prema terapijskom režimu i uzročnoj vrsti mikobakterije. Rano započinjanje terapije moglo bi unaprijediti kratkoročne ishode. Potrebna su daljnja istraživanja kako bi se utvrdio utjecaj na dugoročno preživljenje.
Abstract (english)
Pulmonary manifestations of non-tuberculous mycobacterial infections (NTM-PD) are the most common form of the disease and are increasingly recognized as an important clinical entity in humans, most commonly affecting the elderly population with pre-existing chronic lung disease. The aim of this study was to determine characteristics of NTM-PD patients in Croatia, and record clinical outcomes and long-term survival after therapy completion. This study represents a retrospective cohort study on all Croatian residents with NTM isolates from respiratory samples in the period from 1 January 2006 to 31 December 2015 and a follow-up until 31 December 2018. The data analyzed in this study represent centralized data from the National registry of patients with NTM isolate founded in 2008 and managed at the National Reference Mycobacteria Laboratory (NRML) at the Croatian Institute of Public Health (CIPH), containing clinical, radiological and data on treatment outcomes and date of death. During the observed period, in the NRML a total of 2109 episodes of pulmonary NTM isolates were identified in 2050 patients. Criteria for definite disease were met by 137 (29.3%) while for no disease by 302 (64.3%) from total of 468 episodes with full medical records. Remaining 29 (6.2%) episodes were classified as probable disease. The median age of patients with definitive NTM lung disease was 66.5 (16-90) years. Of the total number of patients in this group, 62 (45.3%) patients were women. The most common comorbidity was chronic obstructive pulmonary disease, in 44.5% of patients. Microbiological cure was observed in 82.8% of patients after adequate NTM treatment, in 64.7% of patients treated with TB protocol, and in 64.3% of patients treated with short NTM protocol while spontaneous culture conversion was observed in 41.2% of untreated patients. In Croatia, NTM-PD was most commonly caused by M. xenopi and MAC with 36.5% 5-year mortality. Guideline-compliant treatment resulted in a four times higher chance of being cured. Treatment outcomes differed with respect to different treatment regimens and causal species. Early treatment initiation may improve short term outcomes while further investigations are needed to determine impact on the long-term survival.
Keywords
Keywords (english)
Languagecroatian
URN:NBNurn:nbn:hr:105:742861
Study programmeTitle: Medicine
Study programme type: university
Study level: integrated undergraduate and graduate
Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
Type of resourceText
File originBorn digital
Access conditionsOpen access
Terms of useLicence In copyright icon
Created on2021-04-22 06:56:03