Improved survival in patients with severe tuberculosis after exposure to fluoroquinolones

doi:10.1080/23744235.2016.1195914

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標題:	Improved survival in patients with severe tuberculosis after exposure to fluoroquinolones
作者:	Chiang, Shyh-Ren Shieh, Jiunn-Min Chen, Chung-Hua Hsing, Shu-Chen Wen, Shih-Feng Wang, Jhi-Joung Cheng, Kuo-Chen Chuang, Yin-Ching
貢獻者:	Chi Mei Med Ctr, Dept Internal Med Chia Nan Univ Pharm & Sci, Dept Gen Educ En Chu Kong Hosp, Dept Internal Med Chi Mei Med Ctr, Dept Resp Care Sect Chi Mei Med Ctr, Dept Med Res Chang Jung Christian Univ, Coll Hlth Sci Chia Nan Univ Pharm & Sci, Dept Hosp & Hlth Care Adm Chung Hwa Univ Med Technol, Dept Safety Hlth & Environm Natl Def Med Ctr, Dept Med Chi Mei Med Ctr Liou Ying, Dept Internal Med
關鍵字:	Antibiotics fluoroquinolone outcomes population-based cohort study tuberculosis moxifloxacin
日期:	2016
上傳時間:	2018-01-18 11:38:27 (UTC+8)
出版者:	Taylor & Francis Ltd
摘要:	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.
關聯:	Infectious Diseases, v.48 n.11-12, pp.789-795
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