Bacterial co-infection and early mortality among pulmonary tuberculosis patients in Manila, The Philippines

OBJECTIVE

To investigate the prevalence of bacterial co-infection and its effect on early mortality among hospitalised human immunodeficiency virus (HIV) negative pulmonary tuberculosis (PTB) patients in Manila, the Philippines.

DESIGN

A prospective observational study was conducted at a national infectious disease hospital. HIV-negative PTB patients aged 13 years hospitalised from November to December 2011 and from December 2012 to May 2013 were enrolled. Sputum samples were tested for Mycobacterium tuberculosis and six respiratory bacterial pathogens using polymerase chain reaction (PCR).

RESULTS

Of 466 patients, 228 (48.9%) were TB-PCR-positive. Overall, bacterial pathogens in purulent sputum were detected in 135 (29.0%) patients: Haemophilus influenzae was the most common bacterium (21.2%), followed by Streptococcus pneumoniae (7.9%). The prevalence of bacterial co-infection did not differ between TB-PCR-positive and -negative patients. A total of 92 (19.7%) patients died within 2 weeks. Bacterial co-infection was significantly associated with an increased risk of 2-week mortality among TB-PCR-positive patients (adjusted risk ratio [aRR] 1.67, 95%CI 1.03-2.72). This association was also observed but did not reach statistical significance among TB-PCR-negative patients (aRR1.7, 95%CI 0.95-3.02).

CONCLUSION

Bacterial co-infection is common and contributes to an increased risk of early mortality among HIV-negative PTB patients.

Risk factors for death among hospitalised tuberculosis patients in poor urban areas in Manila, The Philippines

OBJECTIVE

To determine the mortality rate and risk factors for in-hospital death among hospitalised human immunodeficiency virus (HIV) negative tuberculosis (TB) patients in poor urban areas in the Philippines.

DESIGN

A cross-sectional study was conducted at a national infectious disease hospital in Manila City. The target population was patients aged ≥ 13 years with all forms of HIV-negative TB admitted from October to December 2009. Demographic and clinical information was collected from medical charts, and risk of in-hospital death was measured.

RESULTS

Of 407 HIV-negative TB patients, four were excluded due to missing records, and 403 were included in the analysis. The majority were poor urban residents (90%), and 66% were males. Overall, 37.5% of hospitalised patients died in the hospital (151/403), 30% of whom died before the third day of hospitalisation. Risk factor analysis demonstrated that complications of bacterial pneumonia had the greatest effect on in-hospital death (aOR 4.53, 95%CI 2.65-7.72), followed by anorexia (aOR 3.01, 95%CI 1.55-5.84), anaemia (haemoglobin <10 g/dl, aOR 2.35, 95%CI 1.34-4.13) and older age (aged ≥ 50 years, aOR 1.85, 95%CI 1.08-3.17). The presence of haemoptysis (aOR 0.44, 95%CI 0.25-0.80) was associated with improved survival.

CONCLUSION

Mortality among hospitalised HIV-negative TB patients was extremely high in poor urban areas in the Philippines.