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Drug management of TB in the intensive care setting: an international multicentre study: an international multicentre study

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Title: Drug management of TB in the intensive care setting: an international multicentre study: an international multicentre study
Authors: Tiberi, S, Akkerman, O, Sotgiu, G, Saderi, L, Kunst, H, Carvalho, A C C, Muñoz-Torrico, M, Lui, G C-Y, Rendon, A, Cordeiro Dos Santos, M, Rosso, R G, Mendes, I C, Mendoza, A, Borges, M C, Kritski, A, Marçôa, R, Vieira, M A, Hernandez-Cardenas, C M, Rahman, A, Barrett, J, Shah, K, Wagrell, L, Johnson, E, Hall, J, Sabir, N, Lynn, W, Zolfaghari, P, Duarte, R, Davies Forsman, L, Whittington, A, Martin-Lazaro, J F, White, V, Chen, C, Gray, A, Brown, M, Alffenaar, J-W C, Bruchfeld, J, Centis, R, D'Ambrosio, L, Ruslami, R, Kerstjens, H A M, Zumla, A, Ambrosino, N, Migliori, G B
Source: The International Journal of Tuberculosis and Lung Disease. 29:340-348
Publisher Information: International Union Against Tuberculosis and Lung Disease, 2025.
Publication Year: 2025
Subject Terms: Male, Adult, Tuberculosis/drug therapy, Asia, Critical Care, Antitubercular Agents/administration & dosage, Respiration, Middle Aged, Europe, Intensive Care Units, Young Adult, Treatment Outcome, Latin America, Humans, Female, Artificial/statistics & numerical data, Retrospective Studies, Aged
Description: BACKGROUNDIndividuals requiring admission to an intensive care unit (ICU) due to TB have complex clinical presentations and high mortality rates. There is a clear knowledge gap on how to optimally manage treatment.OBJECTIVETo evaluate the treatment outcomes of TB patients in ICU and explore the potential benefits of intravenous (IV) TB treatment regimens.METHODSA retrospective observational multicentre study was conducted by the International Severe TB and Rehabilitation Working Group of the Global Tuberculosis Network (GTN). The study included TB patients aged >15 years admitted to ICUs in Europe, Asia and Latin America from January 1, 2005 to December 31, 2018. Data on demographics, microbiology, clinical information and treatment outcomes were collected and analysed.RESULTSThe study enrolled 434 cases. Over half were sputum smear-positive and 85.7% were culture-positive. Most required invasive mechanical ventilation, vasopressor support and steroids. Only 48.4% had TB medications initiated before or during ICU admission. The overall mortality rate was 54.8%, with 33.4% achieving treatment success. IV anti-TB drugs were administered to 43% of participants, with levofloxacin and amikacin being the most used. IV treatment longer than 10 days was associated with better outcomes. Individuals receiving IV rifampicin had a lower mortality rate (35.7%) compared to those who did not receive it (51.7%), p-value= 0.05.CONCLUSIONSHigh mortality rates in ICU indicate the need for improved management strategies. The use of IV TB drugs, especially IV rifampicin, show potential benefit, suggesting the need for further prospective studies. Early screening and standardized treatment protocols could improve patient outcomes in high-incidence areas.
Document Type: Article
Language: English
ISSN: 1027-3719
DOI: 10.5588/ijtld.24.0597
Access URL: https://hdl.handle.net/11370/90e38f0a-22cf-41ec-abfa-7d833a230268
https://research.rug.nl/en/publications/90e38f0a-22cf-41ec-abfa-7d833a230268
https://doi.org/10.5588/ijtld.24.0597
Accession Number: edsair.doi.dedup.....9e82dc0e98b115f811d7737659589cb0
Database: OpenAIRE
Description
Abstract:BACKGROUNDIndividuals requiring admission to an intensive care unit (ICU) due to TB have complex clinical presentations and high mortality rates. There is a clear knowledge gap on how to optimally manage treatment.OBJECTIVETo evaluate the treatment outcomes of TB patients in ICU and explore the potential benefits of intravenous (IV) TB treatment regimens.METHODSA retrospective observational multicentre study was conducted by the International Severe TB and Rehabilitation Working Group of the Global Tuberculosis Network (GTN). The study included TB patients aged >15 years admitted to ICUs in Europe, Asia and Latin America from January 1, 2005 to December 31, 2018. Data on demographics, microbiology, clinical information and treatment outcomes were collected and analysed.RESULTSThe study enrolled 434 cases. Over half were sputum smear-positive and 85.7% were culture-positive. Most required invasive mechanical ventilation, vasopressor support and steroids. Only 48.4% had TB medications initiated before or during ICU admission. The overall mortality rate was 54.8%, with 33.4% achieving treatment success. IV anti-TB drugs were administered to 43% of participants, with levofloxacin and amikacin being the most used. IV treatment longer than 10 days was associated with better outcomes. Individuals receiving IV rifampicin had a lower mortality rate (35.7%) compared to those who did not receive it (51.7%), p-value= 0.05.CONCLUSIONSHigh mortality rates in ICU indicate the need for improved management strategies. The use of IV TB drugs, especially IV rifampicin, show potential benefit, suggesting the need for further prospective studies. Early screening and standardized treatment protocols could improve patient outcomes in high-incidence areas.
ISSN:10273719
DOI:10.5588/ijtld.24.0597