|Title:||Concomitant pulmonary tuberculosis in hospitalized healthcare-associated pneumonia in a tuberculosis endemic area: A multi-center retrospective study||Authors:||Feng J.-Y.
|Issue Date:||2012||Journal Volume:||7||Journal Issue:||5||Start page/Pages:||e36832||Source:||PLoS ONE||Abstract:||
Background: In tuberculosis (TB) endemic areas, Mycobacterium tuberculosis is an important but easily misdiagnosed pathogen in community-acquired pneumonia (CAP). However, the occurrence of concomitant pulmonary tuberculosis (PTB) in hospitalized healthcare-associated pneumonia (HCAP) has never been investigated. Methods and Findings: Seven hundred and one hospitalized HCAP and 934 hospitalized CAP patients from six medical centers in Taiwan were included in this nationwide retrospective study. Concomitant PTB was defined as active PTB diagnosed within 60 days of admission due to HCAP or CAP. The predictors for concomitant PTB and the impact of PTB on the outcomes of pneumonia were investigated. Among the enrolled subjects, 21/701 (3%) of the HCAP patients and 25/934 (2.7%) of the CAP patients were documented to have concomitant PTB. In multivariate analysis, a history of previous anti-TB treatment (OR = 5.84, 95% CI: 2.29-20.37 in HCAP; OR = 3.33, 95% CI: 1.09-10.22 in CAP) and escalated pneumonia severity index (PSI) scores (OR = 1.014, 95% CI: 1.002-1.026, in HCAP; OR = 1.013, 95% CI: 1.001-1.026, in CAP) were independent predictors for concomitant PTB in both CAP and HCAP patients. Regarding treatment outcomes, HCAP patients with concomitant PTB were associated with more acute respiratory failure within 48 hours of admission (47.6% vs. 22.6%, p = 0.008), higher intensive care unit admission rate (61.9% vs. 35.7%, p = 0.014), longer hospitalization (39.6±34.1 vs. 23.7±27 days, p = 0.009), and higher in-hospital mortality (47.6% vs. 26.3%, p = 0.03) than those without concomitant PTB. Exposure to certain groups of antibiotics for the treatment of pneumonia was not associated with the occurrence of concomitant PTB. Conclusions: In HCAP patients, the occurrence of concomitant PTB is comparable with that in CAP patients and associated with higher PSI scores, more acute respiratory failure, and higher in-hospital mortality. ? 2012 Feng et al.
|ISSN:||1932-6203||DOI:||10.1371/journal.pone.0036832||SDG/Keyword:||antibiotic agent; carbapenem; cephalosporin; levofloxacin; macrolide; moxifloxacin; penicillin G; tuberculostatic agent; acute respiratory failure; aged; article; community acquired pneumonia; concurrent infection; controlled study; disease association; disease severity; drug exposure; endemic disease; female; health care associated pneumonia; hospital admission; hospitalization; human; intensive care unit; length of stay; lung tuberculosis; major clinical study; male; mortality; Pneumonia Severity Index; prediction; retrospective study; Taiwan; treatment outcome; Adult; Aged; Aged, 80 and over; Community-Acquired Infections; Comorbidity; Female; Hospitalization; Humans; Male; Middle Aged; Pneumonia; Prevalence; Retrospective Studies; Severity of Illness Index; Survival Rate; Taiwan; Tuberculosis, Pulmonary; Mycobacterium tuberculosis
|Appears in Collections:||醫學系|
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