Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia
Journal
Critical Care
Journal Volume
16
Journal Issue
5
Pages
R207
Date Issued
2012
Author(s)
Abstract
Introduction: Empirical use of fluoroquinolones may delay the initiation of appropriate therapy for tuberculosis (TB). This study aimed to evaluate the impact of empirical fluoroquinolone use on the survival of patients with pulmonary TB that mimicked severe community-acquired pneumonia (CAP) requiring intensive care.Methods: Patients aged >18 years with culture-confirmed pulmonary TB who presented as severe CAP and were admitted to the ICU were divided into fluoroquinolone (FQ) and nonfluoroquinolone (non-FQ) groups based on the type of empirical antibiotics used. Those patients with previous anti-TB treatment or those who died within 3 days of hospitalization were excluded. The primary end point was 100-day survival.Results: Of the 77 patients identified, 43 (56%) were in the FQ group and 34 (44%) were in the non-FQ group. The two groups had no statistically significant difference in co-morbidities (95% vs. 97%, P > 0.99) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores (21.2 ± 7.1 vs. 22.5 ± 7.5, P = 0.46) on ICU admission. Overall, 91% and 82% of patients in the FQ and non-FQ groups, respectively, had sputum examinations for TB within 1 week of admission (P = 0.46), and results were positive in 7% and 15% (P = 0.47), respectively. For both groups, 29% received appropriate anti-TB therapy within 2 weeks after ICU admission. The 100-day mortality rate was 40% and 68% for the FQ and non-FQ groups, respectively (P = 0.02). By Cox regression analysis, APACHE score <20, no bacteremia during the ICU stay, and empirical fluoroquinolone use were independently associated with survival.Conclusion: Empirical use of fluoroquinolones may improve the survival of ICU patients admitted for pulmonary TB mimicking severe CAP. ? 2012 Tseng et al.; licensee BioMed Central Ltd.
SDGs
Other Subjects
amoxicillin plus clavulanic acid; ciprofloxacin; ethambutol; isoniazid; levofloxacin; moxifloxacin; pyrazinamide; rifampicin; streptomycin; sultamicillin; antiinfective agent; quinolone derivative; tuberculostatic agent; adult; antibiotic therapy; APACHE; article; bacteremia; community acquired pneumonia; comorbidity; controlled clinical trial; controlled study; critically ill patient; disease severity; female; hospital admission; hospitalization; human; intensive care; intensive care unit; lung tuberculosis; major clinical study; male; mortality; outcome assessment; priority journal; proportional hazards model; sputum culture; statistical significance; survival; aged; Community-Acquired Infections; differential diagnosis; endemic disease; epidemiology; length of stay; pneumonia; retrospective study; statistics and numerical data; Taiwan; Tuberculosis, Pulmonary; Aged; Anti-Bacterial Agents; Antitubercular Agents; APACHE; Bacteremia; Community-Acquired Infections; Diagnosis, Differential; Endemic Diseases; Female; Fluoroquinolones; Humans; Intensive Care Units; Length of Stay; Male; Pneumonia; Retrospective Studies; Taiwan; Tuberculosis, Pulmonary
Type
journal article