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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Mycobacterium tuberculosis septic shock
Chest, Volume 144, No. 2, Year 2013
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Description
Background: Septic shock due to Mycobacterium tuberculosis (MTB) is an uncommon but wellrecognized clinical syndrome. The objective of this study was to describe the unique clinical characteristics, epidemiologic risk factors, and covariates of survival of patients with MTB septic shock in comparison with other bacterial septic shock. Methods: A retrospective nested cohort study was conducted of patients given a diagnosis of MTB septic shock derived from a trinational, 8,670-patient database of patients with septic shock between 1996 and 2007. Results: In the database, 53 patients had been given a diagnosis of MTB shock compared with 5,419 with septic shock associated with isolation of more common bacterial pathogens. Patients with MTB and other bacterial septic shock had in-hospital mortality rates of 79.2% and 49.7%, respectively (P < .0001). Of the cases of MTB shock, all but fi ve patients had recognized respiratory tract involvement. Fifty-fi ve percent of patients (29 of 53) were documented (by direct culture or stain) as having disseminated extrapulmonary involvement. Inappropriate and appropriate initial empirical therapy was delivered in 28 patients (52.8%) and 25 patients (47.2%); survival was 7.1% and 36.0%, respectively (P = .0114). Ten patients (18.9%) did not receive anti-MTB therapy; all died. The median time to appropriate antimicrobial therapy for MTB septic shock was 31.0 h (interquartile range, 18.9-71.9 h). Only 11 patients received anti-MTB therapy within 24 h of documentation of hypotension; six of these (54.5%) survived. Only one of 21 patients (4.8%) who started anti-MTB therapy after 24 h survived (P = .0003 vs < 24 h). Survival differences between these time intervals are not signifi cantly different from those seen with bacterial septic shock due to more common bacterial pathogens. Conclusions: MTB septic shock behaves similarly to bacterial septic shock. As with bacterial septic shock, early appropriate antimicrobial therapy appears to improve mortality. © 2013 American College of Chest Physicians.
Authors & Co-Authors
Kethireddy, Shravan
Canada, Winnipeg
University of Manitoba
Light, R. Bruce
Canada, Winnipeg
University of Manitoba
Mirzanejad, Yazdan
Canada, Surrey
Surrey Memorial Hospital
Maki, Dennis George
United States, Madison
Uw Health
Arabi, Yaseen M.
Saudi Arabia, Riyadh
King Saud Bin Abdulaziz University for Health Sciences
Lapinsky, Stephen Earl
Canada, Toronto
University of Toronto
Simon, David M.
United States, Chicago
Rush University
Kumar, Aseem C.Ramesh
Canada, Sudbury
Université Laurentienne
Parrillo, Joseph E.
United States, Hackensack
Hackensack University Medical Center
Kumar, Anand
Canada, Winnipeg
University of Manitoba
Statistics
Citations: 48
Authors: 10
Affiliations: 8
Identifiers
Doi:
10.1378/chest.12-1286
ISSN:
00123692
e-ISSN:
19313543
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Approach
Quantitative