Mycobacterium tuberculosis Septic Shock.
Chest. 2013 Feb 21;
Authors: Kethireddy S, Light RB, Miranejad Y, Maki D, Arabi Y, Lapinsky S, Simon D, Kumar A, Parrillo JE, Kumar A
Abstract
ABSTRACT BACKGROUND: Septic shock due to M. tuberculosis (MTB) is an uncommon but well recognized clinical syndrome. OBJECTIVES: To describe the unique clinical characteristics, epidemiologic risk factors and covariates of survival of patients with MTB septic shock in comparison to other bacterial septic shock. METHODS: A retrospective nested cohort study of patients diagnosed with MTB septic shock derived from a tri-national, 8670 patient database of patients with septic shock between 1996 and 2007. RESULTS: In the database, 53 patients were diagnosed with MTB shock compared to 5419 with septic shock associated with isolation of more common bacterial pathogens. Patients with MTB and other bacterial septic shock had an in-hospital mortality of 79.2% and 49.7% respectively (p<.0001). Of the cases of MTB shock, all but 5 patients had recognized respiratory tract involvement. Fifty-five percent (29/53) patients were documented (by direct culture or stain) as having disseminated extra-pulmonary involvement . Inappropriate and appropriate initial empiric therapy was delivered in 28 (52.8%) and 25 (47.2%); survival was 7.1% and 36.0% respectively (p=.0114). Ten (18.9%) patients never received anti-MTB therapy; all died. The median time to appropriate antimicrobial therapy for MTB septic shock was 31.0 (18.9-71.9 interquartile range [IQR]) hrs. Only 11 patients received anti-MTB within 24 hours of documentation of hypotension; 6 (54.5%) of these survived. Only 1 of 21 (4.8%) patients who started anti-MTB therapy after 24 hours survived (p=.0003 vs <24 hrs). Survival differences between these time intervals are not significantly different than 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.
PMID: 23429859 [PubMed - as supplied by publisher]