AMJ Vol 9 No 4 Desember 2022 Final.indd Althea Medical Journal. 2022;9(4) 206 Distribution of Rifampicin-Resistant Tuberculosis Patients based on Presumptive Drug-Resistant Tuberculosis Criteria at Dr. Hasan Sadikin Hospital 2016–2019 Dinda Nursyafira Misyatin,1 Arto Yuwono Soeroto,2 Ferdy Ferdian2 1Faculty of Medicine Universitas Padjadjaran, Indonesia, 2Departement of Internal Medicine, Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia Correspondence: Dinda Nursyafira Misyatin, Faculty of Medicine Universitas Padjadjaran, Jalan Raya Bandung Sumedang KM 21, Jatinangor, Sumedang, Indonesia, E-mail: dinda17009@mail.unpad.ac.id Introduction Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis, is still a significant health problem in Indonesia. This disease ranks third in the world after India and China. In 2018, approximately 845,000 cases were reported in Indonesia, of which 240,000 cases were drug-resistant (DR)-TB. The high number of DR-TB makes the disease still a burden,1 with the highest TB incidence rate in West Java Province. Dr. Hasan Sadikin General Hospital Bandung has been the primary referral for DR-TB in West Java since 2012. There are 15,393 presumptive DR-TB patients and 1,779 DR-TB patients in 2012–2019.2 Diagnosis of DR-TB begins with identifying presumptive DR-TB patients with one or more of 9 presumptive DR-TB criteria based on the Regulation of the Ministry of Health of the Republic of Indonesia no. 67/2016.3 Xpert MTB/RIF has tested the presumptive DR-TB patients to detect the resistance. Moreover, Xpert MTB/RIF gives Ct values as a potential measure of bacterial burden.4 The bacterial load before treatment affects the time needed for the eradication.5 The information about Ct values among nine presumptive DR-TB criteria can be a reference for clinicians to focus more on specific criteria, which can result in a higher treatment success rate. This study aimed to identify the distribution of RR-TB patients based on nine presumptive DR-TB criteria and Xpert MTB/RIF Ct values at Dr. Hasan Sadikin General Hospital Bandung. Methods This descriptive study collected and analyzed data from the e-TB Manager and medical Althea Medical Journal. 2022;9(4):206–211 Abstract Background: Diagnosis of drug-resistant tuberculosis (DR-TB) begins with identifying presumptive DR-TB patients using Xpert MTB/RIF, as a diagnostic test to detect resistance to rifampicin. The study aimed to identify the distribution of rifampicin-resistant tuberculosis (RR-TB) patients based on presumptive DR-TB criteria at Dr. Hasan Sadikin General Hospital Bandung. Moreover, this study also explored the Xpert MTB/RIF Ct values. Methods: This was a descriptive-retrospective study from 570 medical records of DR-TB patients collected at the Multidrug-resistant tuberculosis (MDR-TB) clinic of Dr. Hasan Sadikin General Hospital from 2016 to 2019. The inclusion criteria were suspected patients with the Xpert MTB/RIF Ct values in the very low-low and medium-high categories. Data were analyzed using frequency distribution. Results: The most common presumptive DR-TB criteria among DR-TB patients were relapse cases (52.3%). Presumptive DR-TB criteria, with a high percentage result of medium-high Ct values, were category II treatment failure (80.9%). Conclusion: Relapse case and category II treatment failure are presumptive DR-TB criteria, which need more attention from clinicians. Keywords: Presumptive DR-TB criteria, tuberculosis, Xpert MTB/RIF Ct values https://doi.org/10.15850/amj.v9n4.2593 Althea Medical Journal. 2022;9(4) 207 records of the DR-TB patients in the MDR-TB clinic at Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia. The data collected was from 2016 to 2019, using the total sampling method. The inclusion criteria of this study were all medical records of DR-TB patients that had information about the patient’s presumptive DR-TB criteria and Xpert MTB/RIF Ct values. Incomplete medical records were excluded. This study was approved by the Health Research Ethics Committee Universitas Padjadjaran, with Ethical clearance no. 835/UN6.KEP/EC/2020. The nine presumptive DR-TB criteria were based on the Ministry of Health Regulation no. 67/2016. The nine criteria consisted of category II treatment failure, TB patients whose sputum remained smear-positive after three months of treatment, those with a history of non-standard treatment, and those who used quinolones or 2nd line drug injection for at least one month. Included was the category I treatment failure: TB patients whose sputum remained smear-positive after two months of treatment, relapsed, returned after default, and presumptive TB close contacts of a known DR-TB patient, and TB-human immunodeficiency virus (HIV) co-infection who was unresponsive to TB treatment. The frequency and percentage of each presumptive DR-TB criteria were calculated. Ct values were semi-quantitative, which provided results that categorized values as high (Ct≤16), medium (16 22). Presumptive DR-TB criteria and Xpert MTB/RIF Ct values were analyzed using descriptive statistical analysis. Results In total, 570 medical records on presumptive DR-TB throughout 2016–2019 were analyzed. The most common presumptive DR-TB criteria which gave a positive result for DR-TB were relapse cases (52.3%). Next, was the category I treatment failure (16.7%), and the return after default (14.0%) (Table 1). Interestingly, relapse cases had a high number in both medium-high and very low-low Ct values (Figure 1). Xpert MTB/RIF was used to test patients, which gave Ct values that were representative of the bacterial burden. The criteria for presumptive TB-DR had a high percentage of having a high bacterial burden based on Xpert MTB/RIF Ct values (Table 2). The criteria for presumptive DR-TB with a high percentage of medium-high Ct values were category II treatment failure (80.9%). Then, the following were TB patients whose sputum remained smear-positive after two months of category I treatment (75.0%), category I treatment failure (73.6%) and relapse case (72.2%) (Table 2). Table 1 Frequency of Patients at Dr. Hasan Sadikin General Hospital period 2016–2019 based on Presumptive DR-TB Criteria (Minister of Health Decree No. 67/2016)3 Presumptive DR-TB Criteria DR-TB Patient (n=570) n % 1. Category II treatment failure 21 3.7 2. TB patients whose sputum remains smear-positive after 3 months of category II treatment 16 2.8 3. TB patients who have a history of non-standard treatment and use quinolones or 2nd line drug injections for at least one month 18 3.2 4. Category I treatment failure 95 16.7 5. TB patients whose sputum remains smear-positive after two months of category I treatment 32 5.6 6. Relapse 298 52.3* 7. Return after default 80 14.0 8. Presumptive TB close contacts of a known DR-TB patient 8 1.4 9. TB-HIV co-infection who did not respond to TB treatment 2 0.3 Note. * the most common presumptive DR-TB criteria Dinda Nursyafira Misyatin et al.:Distribution of Rifampicin-Resistant Tuberculosis Patients based on Presumptive Drug-Resistant Tuberculosis Criteria at Dr. Hasan Sadikin Hospital 2016–2019 Althea Medical Journal. 2022;9(4) 208 Table 2 Xpert MTB/RIF Ct Values on Presumptive DR-TB Criteria3 Presumptive DR-TB Criteria Xpert MTB/RIF Ct values VL-L M-H n % n % 1. Category II treatment failure 4 19.1 17 80.9 2. TB patients whose sputum remains smear-positive after 3 months of category II treatment 6 37.4 10 62.6 3. TB patients who have a history of non-standard treatment and use quinolones or 2nd line drug injections for at least one month 8 44.4 10 55.6 4. Category I treatment failure 25 26.4 70 73.6 5. TB patients whose sputum remains smear-positive after two months of category I treatment 8 25.0 24 75.0 6. Relapse 83 27.8 215 72.2 7. Return after default 27 33.7 53 66.3 8. Presumptive TB close contacts of a known DR-TB patient 5 62.5 3 37.5 9. TB-HIV co-infection who did not respond to TB treatment 1 50.0 1 50.0 Note: H=high (Ct≤16), M=Medium (16