Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia.docVIP

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Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia.doc

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Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia

Tsengetal.CriticalCare2012,16:R207 /content/16/5/R207 RESEARCH OpenAccess Empiricaluseoffluoroquinolonesimproves thesurvivalofcriticallyillpatientswith tuberculosismimickingseverepneumonia Yu-TzuTseng1,Yu-ChungChuang2,Chin-ChungShu1,Chien-ChingHung2,Chiung-FangHsu2and Jann-YuanWang2* Abstract Introduction:Empiricaluseoffluoroquinolonesmaydelaytheinitiationofappropriatetherapyfortuberculosis (TB).Thisstudyaimedtoevaluatetheimpactofempiricalfluoroquinoloneuseonthesurvivalofpatientswith pulmonaryTBthatmimickedseverecommunity-acquiredpneumonia(CAP)requiringintensivecare. Methods:Patientsaged18yearswithculture-confirmedpulmonaryTBwhopresentedassevereCAPandwere admittedtotheICUweredividedintofluoroquinolone(FQ)andnonfluoroquinolone(non-FQ)groupsbasedon thetypeofempiricalantibioticsused.Thosepatientswithpreviousanti-TBtreatmentorthosewhodiedwithin3 daysofhospitalizationwereexcluded.Theprimaryendpointwas100-daysurvival. Results:Ofthe77patientsidentified,43(56%)wereintheFQgroupand34(44%)wereinthenon-FQgroup.The twogroupshadnostatisticallysignificantdifferenceinco-morbidities(95%vs.97%,P0.99)andAcute PhysiologyandChronicHealthEvaluation(APACHE)IIscores(21.2±7.1vs.22.5±7.5,P=0.46)onICUadmission. Overall,91%and82%ofpatientsintheFQandnon-FQgroups,respectively,hadsputumexaminationsforTB within1weekofadmission(P=0.46),andresultswerepositivein7%and15%(P=0.47),respectively.Forboth groups,29%receivedappropriateanti-TBtherapywithin2weeksafterICUadmission.The100-daymortalityrate was40%and68%fortheFQandnon-FQgroups,respectively(P=0.02).ByCoxregressionanalysis,APACHEscore 20,nobacteremiaduringtheICUstay,andempiricalfluoroquinoloneusewereindependentlyassociatedwith survival. Conclusion:EmpiricaluseoffluoroquinolonesmayimprovethesurvivalofICUpatientsadmittedforpulmonary TBmimickingsevereCAP. Introduction than using the combination therapy of b-lactams plus Severe community-acquired pneumonia(CAP),defined macrolides[3,4]. as pneumonia acquired in the commu