Bacterial pneumonia and mortality in hospitalized patients with pulmonary tuberculosis and mechanical ventilation
Abstract
OBJECTIVE
To evaluate the association between bacterial pneumonia and mortality in hospitalized patients with pulmonary tuberculosis requiring mechanical ventilation (PTMV).
METHODS
A retrospective cohort study conducted at Khon Kaen Hospital, Thailand. We reviewed medical records of hospitalized patients with the diagnosis of pulmonary tuberculosis with ventilator treatment from December 2009 to November 2012. The exposure of our study was the bacterial infection of lungs regardless of the type of bacterial. Our primary outcome was mortality within 90 days after admission. Our secondary outcomes included length on ventilator and length of hospital stay.
RESULTS
Of 326 hospitalized patients with pulmonary tuberculosis requiring PTMV, there were 206 patients with bacterial pneumonia and 120 patients without bacterial pneumonia. The mortality rate was significantly higher in those with bacterial pneumonia than those without bacterial pneumonia (relative risk (RR), 1.51; 95% confidence interval (CI),1.07 to 2.12). However, the Cox regression analysis showed no difference in mortality within 90 days after admission between the two groups (hazard ratio, 1.28; 95%CI, 0.96 to 1.69).
CONCLUSION
The current retrospective cohort study showed no significant difference in mortality rate within 90 days after admission between hospitalized patients with the diagnosis of pulmonary tuberculosis with bacterial pneumonia and without bacterial pneumonia.
References
Global tuberculosis report 2016 [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1
Bridges DA, Bedimo RG. Severe tuberculosis sepsis in an immunocompetent patient. Am J Med. 2006 Mar;119(3):e11-14.
Zahar J-R, Azoulay E, Klement E, De Lassence A, Lucet J-C, Regnier B, et al. Delayed treatment contributes to mortality in ICU patients with severe active pulmonary tuberculosis and acute respiratory failure. Intensive care medicine. 2001;27(3):513–520.
Balkema CA, Irusen EM, Taljaard JJ, Koegelenberg CFN. Tuberculosis in the intensive care unit: a prospective observational study. Int J Tuberc Lung Dis. 2014 Jul;18(7):824–30.
Valade S, Raskine L, Aout M, Malissin I, Brun P, Deye N, et al. Tuberculosis in the intensive care unit: A retrospective descriptive cohort study with determination of a predictive fatality score. Can J Infect Dis Med Microbiol. 2012;23(4):173–8.
Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2005 Jul;9(7):777–83.
Rao VK, Iademarco EP, Fraser VJ, Kollef MH. The impact of comorbidity on mortality following in-hospital diagnosis of tuberculosis. Chest. 1998 Nov;114(5):1244–52.
Ryu YJ, Koh W-J, Kang EH, Suh GY, Chung MP, Kim H, et al. Prognostic factors in pulmonary tuberculosis requiring mechanical ventilation for acute respiratory failure. Respirology. 2007 May;12(3):406–11.
Erbes R, Oettel K, Raffenberg M, Mauch H, Schmidt-Ioanas M, Lode H. Characteristics and outcome of patients with active pulmonary tuberculosis requiring intensive care. Eur Respir J. 2006 Jun;27(6):1223–8.
Hagan G, Nathani N. Clinical review: Tuberculosis on the intensive care unit. Critical Care. 2013 Sep 27;17:240.
Silva DR, Menegotto DM, Schulz LF, Gazzana MB, Dalcin PT. Mortality among patients with tuberculosis requiring intensive care: a retrospective cohort study. BMC Infect Dis. 2010 Mar 7;10:54.
Deng W, Yu M, Ma H, Hu LA, Chen G, Wang Y, et al. Predictors and outcome of patients with acute respiratory distress syndrome caused by miliary tuberculosis: a retrospective study in Chongqing, China. BMC Infectious Diseases. 2012 May 20;12:121.
Duro RP, Figueiredo Dias P, Ferreira AA, Xerinda SM, Lima Alves C, Sarmento A, et al. Severe Tuberculosis Requiring Intensive Care: A Descriptive Analysis [Internet]. Critical Care Research and Practice. 2017 [cited 2017 Oct 15]. Available from: https://www.hindawi.com/journals/ccrp/2017/9535463/
Waitt CJ, Squire SB. A systematic review of risk factors for death in adults during and after tuberculosis treatment. The International Journal of Tuberculosis and Lung Disease. 2011;15(7):871–885
Shimazaki T, Marte SD, Saludar NRD, Dimaano EM, Salva EP, Ariyoshi K, et al. Risk factors for death among hospitalised tuberculosis patients in poor urban areas in Manila, The Philippines. Int J Tuberc Lung Dis. 2013 Nov;17(11):1420–6
Lin S-M, Wang T-Y, Liu W-T, Chang C-C, Lin H-C, Liu C-Y, et al. Predictive factors for mortality among non-HIV-infected patients with pulmonary tuberculosis and respiratory failure. Int J Tuberc Lung Dis. 2009 Mar;13(3):335–40.
Kim S, Kim H, Kim WJ, Lee S-J, Hong Y, Lee H-Y, et al. Mortality and predictors in pulmonary tuberculosis with respiratory failure requiring mechanical ventilation. Int J Tuberc Lung Dis. 2016 Apr;20(4):524–9.
Bhurayanontachai R, Maneenil K. Factors influencing development and mortality of acute respiratory failure in hospitalized patient with active pulmonary tuberculosis: a 10-year retrospective review. J Thorac Dis. 2016 Jul;8(7):1721–30.
Lee PL, Jerng JS, Chang YL, Chen CF, Hsueh PR, Yu CJ, et al. Patient mortality of active pulmonary tuberculosis requiring mechanical ventilation. Eur Respir J. 2003 Jul;22(1):141–7.
Kim YJ, Pack KM, Jeong E, Na JO, Oh Y-M, Lee SD, et al. Pulmonary tuberculosis with acute respiratory failure. European Respiratory Journal. 2008 Dec 1;32(6):1625–30.
Kim CW, Kim S-H, Lee SN, Lee SJ, Lee MK, Lee J-H, et al. Risk Factors Related with Mortality in Patient with Pulmonary Tuberculosis. Tuberc Respir Dis (Seoul). 2012 Jul;73(1):38–47.
Lin C-H, Lin C-J, Kuo Y-W, Wang J-Y, Hsu C-L, Chen J-M, et al. Tuberculosis mortality: patient characteristics and causes. BMC Infectious Diseases. 2014 Jan 3;14:5.
Tocque K, Convrey RP, Bellis MA, Beeching NJ, Davies PD. Elevated mortality following diagnosis with a treatable disease: tuberculosis. The International Journal of Tuberculosis and Lung Disease. 2005;9(7):797–802.
Lubart E, Lidgi M, Leibovitz A, Rabinovitz C, Segal R. Mortality of patients hospitalized for active tuberculosis in Israel. Isr Med Assoc J. 2007 Dec;9(12):870–3.
Golsha R, Kashani L, Okhly M, Keshtkar AA, Golshah E, Momtaz NS. Pulmonary tuberculosis in patients with chronic renal failure. Saudi Journal of Kidney Diseases and Transplantation. 2014;25(2):428.
