Tuberculosis in the intensive care unit: alternative treatment regimens and association with mortality

• Published in: Tropical medicine & international health 2021-01, Vol.26 (1), p.111-114
• Main Authors: Anton, Camila, Lemos, Carolina Xavier, Machado, Felipe Dominguez, Bernardi, Rafaela Manzoni, Freitas, Alana Ambos, Silva, Denise Rossato
• Format: Article
• Language: English
• Subjects: Albumins; Amikacin; Diagnostic systems; Ethambutol; Intensive care; intensive care unit; Isoniazid; Levofloxacin; mechanical ventilation; Mortality; Multivariate analysis; Patients; Pyrazinamide; respiratory insufficiency; rifampicin; Rifampin; Streptomycin; Tuberculosis
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/tmi.13511

Objectives Adequate anti‐tuberculosis (TB) treatment is an important factor that can affect the patient's outcome. Higher mortality is found in patients who do not receive optimal treatment that includes isoniazid and rifampicin. The objective of this study is to evaluate the association of use of alternative TB treatment regimens (without rifampicin and isoniazid) and mortality among patients requiring intensive care. Methods Retrospective cohort study, from January 2010 to December 2018. Patients aged > 18 years with a TB diagnosis, admitted to the ICU of a general, tertiary care, university‐affiliated hospital (Hospital de Clínicas de Porto Alegre – HCPA) were included. Data on TB treatment used and outcomes of treatment were collected. Results 462 patients met the inclusion criteria and were included in the analysis; 284 used the usual treatment regimen (rifampicin, isoniazid, pyrazinamide and ethambutol – all orally), and 178 used alternative treatment regimens (IV levofloxacin plus oral ethambutol plus IM streptomycin or IV amikacin, without rifampicin and isoniazid). The mortality was higher among users of alternative treatment regimens (63.5%) than among usual treatment regimen users (51.4%) (P = 0.011). In a multivariate analysis, age, albumin and death were independently associated with alternative treatment regimens use. Conclusions TB programmes in which IV rifampicin is not widely available should consider including it, especially for critically ill TB patients, for whom there may be improved survival. ObjectifsUn traitement antituberculeux (TB) adéquat est un facteur important pouvant influencer les résultats du patient. Une mortalité plus élevée est observée chez les patients qui ne reçoivent pas un traitement optimal comprenant de l'isoniazide et de la rifampicine. L'objectif de cette étude est d'évaluer l'association entre l'utilisation d'autres schémas thérapeutiques anti‐TB (sans rifampicine ni isoniazide) et la mortalité chez les patients nécessitant des soins intensifs.MéthodesEtude de cohorte rétrospective, de janvier 2010 à décembre 2018. Les patients âgés de >18 ans avec un diagnostic de TB, admis à l'unité de soins intensifs d'un hôpital général, avec des soins tertiaires, affilié à l'Université (Hôpital de Clínicas de Porto Alegre‐HCPA) ont été inclus. Des données sur le traitement anti‐TB utilisé et les résultats du traitement ont été collectés.Résultats462 patients répondaient aux critères d'inclusion et ont été inclus dans l'an