Tuberkulosis resistan obat merupakan tantangan penting dalam pengendalian TBC karena berpotensi meningkatkan risiko kematian selama pengobatan. Penelitian ini bertujuan mengestimasi pengaruh TBC resistan rifampisin (RR), monoresistan isoniazid (Mono-INH), dan multidrug-resistant (MDR) terhadap risiko kematian dibandingkan TBC sensitif obat (SO). Penelitian ini menggunakan desain kohort retrospektif dengan data SITB kohort tahun 2023. Analisis dilakukan secara terpisah untuk perbandingan TBC RR, Mono-INH, dan MDR dengan TBC SO. Risiko kumulatif kematian dihitung pada setiap kelompok, sedangkan risk ratio diestimasi menggunakan regresi Cox dengan waktu pengamatan konstan dan galat baku robust. Populasi penelitian terdiri atas 589.187 pasien TBC SO, 5.096 pasien TBC RR, 149 pasien TBC Mono-INH, dan 4.110 pasien TBC MDR. Risiko kematian selama pengobatan pada TBC SO sebesar 4,54%, dibandingkan 16,15% pada TBC RR, 4,03% pada TBC Mono-INH, dan 15,50% pada TBC MDR. Setelah dikontrol terhadap kelompok umur, pasien TBC RR memiliki risiko kematian 3,94 kali dibandingkan pasien TBC SO (aRR=3,94; IK 95%: 3,66–4,25). Pasien TBC MDR memiliki risiko kematian 3,60 kali dibandingkan pasien TBC SO setelah dikontrol terhadap kelompok umur (aRR=3,60; IK 95%: 3,30–3,92). Pada TBC Mono-INH, tidak terdapat variabel yang memenuhi kriteria sebagai perancu, dan tidak ditemukan bukti statistik adanya perbedaan risiko kematian dibandingkan TBC SO (aRR=1,18; IK 95%: 0,54–2,57). TBC RR dan TBC MDR berhubungan kuat dengan peningkatan risiko kematian selama pengobatan dibandingkan TBC SO, sedangkan hasil pada TBC Mono-INH perlu ditafsirkan hati-hati karena jumlah kasus dan kejadian kematian yang kecil. Temuan ini mendukung perlunya pemantauan lebih intensif pada pasien TBC RR dan TBC MDR sejak awal pengobatan, terutama pada pasien berusia lebih tua, sebagai kelompok berisiko tinggi terhadap kematian selama pengobatan.

Drug-resistant tuberculosis is an important challenge in TB control because it may increase the risk of death during treatment. This study aimed to estimate the effect of rifampicin-resistant TB (RR-TB), isoniazid-monoresistant TB (Mono-INH-TB), and multidrug-resistant TB (MDR-TB) on the risk of death compared with drug-susceptible TB (DS-TB). A retrospective cohort study was conducted using 2023 cohort data from the Tuberculosis Information System (SITB). Separate analyses were performed for the comparisons of RR-TB, Mono-INH-TB, and MDR-TB with DS-TB. The cumulative risk of death was calculated for each group, and risk ratios were estimated using Cox regression with constant follow-up time and robust standard errors. The study population included 589,187 patients with DS-TB, 5,096 with RR-TB, 149 with Mono-INH-TB, and 4,110 with MDR-TB. The risk of death during treatment was 4.54% among patients with DS-TB, compared with 16.15% among patients with RR-TB, 4.03% among patients with Mono-INH-TB, and 15.50% among patients with MDR-TB. After adjustment for age group, patients with RR-TB had 3.94 times the risk of death compared with patients with DS-TB (aRR=3.94; 95% CI: 3.66–4.25). Patients with MDR-TB had 3.60 times the risk of death compared with patients with DS-TB after adjustment for age group (aRR=3.60; 95% CI: 3.30–3.92). For Mono-INH-TB, no variable met the criterion for confounding, and no statistical evidence of a difference in mortality risk compared with DS-TB was found (aRR=1.18; 95% CI: 0.54–2.57). RR-TB and MDR-TB were strongly associated with increased risk of death during treatment compared with DS-TB, while the Mono-INH-TB findings should be interpreted cautiously due to the small number of cases and deaths. These findings support more intensive monitoring of patients with RR-TB and MDR-TB from treatment initiation, particularly among older patients.