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Chiang SR, Shieh JM, Chen CH, Hsing SC, Wen SF, Wang JJ, Cheng KC, Chuang YC. Improved survival in patients with severe tuberculosis after exposure to fluoroquinolones. Infect Dis (Lond) 2016; 48:789-95. [PMID: 27329552 DOI: 10.1080/23744235.2016.1195914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND The clinical impact of prior exposure to antibiotics on patients with tuberculosis (TB) is largely unknown. This study investigated the survival of patients with severe TB after exposure to a variety of antibiotics. METHODS A retrospective cohort study was conducted in TB patients with prior exposure to fluoroquinolones (FQs) (FQ group), to third-generation cephalosporins (CEPH group), and to third-generation penicillins (PCN group). To understand the impact of monotherapy with antibiotics on survival, patients with prior exposure to only moxifloxacin, ceftriaxone, or piperacillin were investigated. RESULTS Patients in the FQ group (N= 401) had a significantly higher survival rate (82.5%) than patients in the CEPH (N = 210) and PCN (N = 172) groups (67.6% and 62.8%, respectively; both p < 0.0001) at 180 d after TB diagnosis. Adjusted odds ratio (AOR) logistic regression analysis demonstrated that patients in the FQ group had significantly more favourable outcomes than those in the CEPH and PCN groups in terms of intensive care unit (ICU) admission rate (versus CEPH cohort: AOR, 1.70; 95% CI: 1.16-2.50; p = 0.0067, versus PCN cohort: AOR, 3.58; 95% CI: 2.42-5.29; both p < 0.0001), mechanical ventilation rate (versus CEPH cohort: AOR, 1.70; 95% CI: 1.09-2.66; p = 0.0205, versus PCN cohort: AOR, 3.92; 95% CI: 2.54-6.05; both p < 0.0001), and acute respiratory failure rate (versus CEPH cohort: AOR, 1.62; 95% CI: 1.07-2.45; p = 0.0223, versus PCN cohort: AOR, 4.29; 95% CI: 2.86-6.43; both p < 0.0001). TB patients with prior exposure to moxifloxacin (N = 198) had a significantly higher survival rate (85.9%) than that of patients with exposure to ceftriaxone (N = 119) and piperacillin (N = 172) monotherapy (survival rates: 69.8% and 62.8%, respectively; both p < 0.001). CONCLUSIONS TB patients with prior exposure to FQs had more favourable outcomes compared with patients who had prior exposure to third-generation cephalosporins or third-generation penicillins. This study provides new insights into the impact of previous exposure to FQs on the survival of TB patients.
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Affiliation(s)
- Shyh-Ren Chiang
- a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;,b Department of General Education , Chia Nan University of Pharmacy and Science , Tainan , Taiwan
| | - Jiunn-Min Shieh
- a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;,b Department of General Education , Chia Nan University of Pharmacy and Science , Tainan , Taiwan
| | - Chung-Hua Chen
- c Department of Internal Medicine , En Chu Kong Hospital , New Taipei City , Taiwan
| | - Shu-Chen Hsing
- d Departments of Respiratory Care Section , Chi Mei Medical Center , Tainan , Taiwan ;,f College of Health Sciences , Chang Jung Christian University , Tainan , Taiwan
| | - Shih-Feng Wen
- e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan ;,g Department of Hospital and Health Care Administration , Chia Nan University of Pharmacy and Science , Tainan , Taiwan
| | - Jhi-Joung Wang
- e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan
| | - Kuo-Chen Cheng
- a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;,h Department of Safety Health and Environment , Chung Hwa University of Medical Technology , Tainan , Taiwan ;,i Department of Medicine , National Defense Medical Center , Taipei , Taiwan
| | - Yin-Ching Chuang
- e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan ;,j Department of Internal Medicine , Chi Mei Medical Center-Liou Ying , Tainan City , Taiwan
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