A retrospective descriptive study on pulmonary tuberculosis patients in ICU

Abstract

Background Mycobacterium tuberculosis (MTB) is an endemic disease in Hong Kong. The annual notification rate was 74.2 per 100, 000 population (1) compared with 3.8 per 100,000 population in the United States in 2009 (2). The reported hospital mortality of MTB admitted to intensive care unit (ICU) was 67-81% (3). This study aims at reviewing the characteristics and outcomes of pulmonary tuberculosis patients admitted to ICU in a local tertiary hospital. Objective To describe the demographic data, all-cause mortality, rate of developing concomitant bacterial infection, anti-tuberculosis drugs prescription pattern and the rate of drug induced side effects such as hepatotoxicity in patients with tuberculosis admitted to ICU. Design Retrospective descriptive study conducted in a mixed surgical and medical ICU in Hong Kong. Patients were critically ill patients diagnosed to have active MTB from January 2004 to December 2009. Results Eighty five patients were identified with active MTB in the study period. The mean age was 55.1±1.7 years old. Twenty six (30.6%) of the patients were above 65 years old. Seventy one (83.5%) of the patients were male. Twenty one (24.7%) of the patients had history of tuberculosis. Thirty two (37.7%) of the patients presented with fever for more than 1 week; 35 patients (41.2%) presented with subjective weight lost and 60% admitted to ICU due to respiratory failure. Sixty nine (81.2%) of the patients were intubated. Fifty seven (67.1%) of the patients had at least four types of anti-TB drugs started during hospitalization. Sixty (70%) of the patients had both isoniazid and rifampicin included in their anti-TB regimen. Eleven (16.7%) of the patients receiving anti-TB treatment were complicated with drug-induced hepatotoxicity. Thirteen (15.3%) patients were diagnosed by physicians to have hospital acquired pneumonia during ICU stay. The ICU all-cause mortality was 54.8% and the hospital mortality was 58.8%.