Abstract
IntroductionEmpirical 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.MethodsPatients 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.ResultsOf 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.ConclusionEmpirical use of fluoroquinolones may improve the survival of ICU patients admitted for pulmonary TB mimicking severe CAP.
Highlights
Empirical use of fluoroquinolones may delay the initiation of appropriate therapy for tuberculosis (TB)
Of the 77 patients presenting severe community-acquired pneumonia (CAP), empirical FQs were given to 43 patients before the date of diagnosis of culture-confirmed pulmonary TB (FQ group), including 30 patients who received levofloxacin, seven ciprofloxacin, and seven moxifloxacin
Despite concerns that empirical use of FQs for severe CAP may be associated with delayed diagnosis and treatment of pulmonary TB [11,33], the findings in this study suggest that empirical use of FQs may improve the prognosis of TB patients presenting as severe CAP that require intensive care
Summary
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. In patients presenting with severe CAP, fluoroquinolones (FQs) have been recommended as first-line empiric antibiotic therapy due to their broad-spectrum antimicrobial effect [2]. FQs have excellent in vitro and in vivo bactericidal activity against Mycobacterium tuberculosis [7,8,9], empirical use of FQ monotherapy for CAP has raised concerns regarding delays in the initiation of appropriate anti-TB therapy, an increase in mortality and the emergence of drug resistance [10,11,12,13]. In different TB endemic areas, it is difficult to define the relationship between the duration of FQ exposure and the development of resistance to FQ
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