Impact of fluoroquinolone exposure on the diagnosis and prognosis of tuberculosis in immunocompromised patients: a propensity-score-matched, competing risk analysis.

Abstract

Objectives: Tuberculosis (TB) in immunocompromised patients presents a significant diagnostic challenge. These patients are sometimes empirically treated with quinolones before a definitive diagnosis is established. However, there are limited data on the impact of fluoroquinolone exposure on TB diagnosis and outcomes in these patients.

Methods: We retrospectively analysed immunocompromised adults with missed TB diagnoses who did not receive anti-TB therapy before obtaining positive mycobacterial culture results, from January 2011 to December 2023. Patients were categorized according to their fluoroquinolone exposure. Propensity score matching, survival analysis, and competing risk analysis were performed to evaluate the association between fluoroquinolone exposure and its impact on diagnostic timelines and patient mortality.

Results: Among 373 immunocompromised patients with missed diagnosis, 97 (26%) received empirical fluoroquinolone therapy before anti-TB therapy. These patients were propensity-score-matched 1:1 to 97 patients who did not receive fluoroquinolone therapy. Fluoroquinolone exposure before sampling did not significantly delay the time to microbiological diagnosis (median 21 days, IQR 17-29 versus 21 days, IQR 17.5-27, P = 0.75) or initiation of anti-TB therapy (median 27 days, IQR 21-34.75 versus 28 days, IQR 22-38, P = 0.76). Survival analysis showed that fluoroquinolone exposure was not significantly associated with 90-day all-cause mortality (P = 0.44), and competing risk analysis showed that fluoroquinolone exposure was not significantly associated with TB-related death (sub-distribution hazard ratio 1.53, 95% CI 0.26-9.03, P = 0.64).

Conclusion: Fluoroquinolone exposure in immunocompromised patients with TB did not adversely affect diagnostic timelines or mortality outcomes.