Enteral Anti-Tuberculosis Drugs Regimen Contributes to Mortality in Critical Patients with Smear Positive Pulmonary Tuberculosis

Abstract

In severe pulmonary tuberculosis that requiring ventilation and critical care should have uncertain enteral absorption. This study aimed to evaluate the impact of enteral anti-tuberculosis regimen used on the survival of patients with smear positive pulmonary tuberculosis requiring mechanical ventilation. Patients aged >15 years with critical smear positive pulmonary tuberculosis were divided into enteral and parenteral antituberculosis drugs regimen groups based on the type of anti-tuberculosis used. Those patients who died or discharged within 24 hours of hospitalization were excluded. The primary endpoint was 40-day survival. In 5844 patients of tuberculosis from 2013 to 2018 have 675 patients identified that smear positive pulmonary tuberculosis, 657 were in enteral drugs group and 18 were in the parenteral fluoroquinolones group, 140 patients die and 535 patients survived. The two groups had statistically significant difference in acute respiratory failure and shock. There had no statistically significant difference between two groups in mortality by univariable risk ratio regression analysis. In generally parenteral regimens are increase mortality rate, but after adjusted all variable factors by multivariable risk ratio regression analysis, there had statistically significant difference between two groups in mortality (risk ratio=1.80; 95%confidence interval=1.25 to 2.58; P=0.001). The medial survival was 8 and 34 days in enteral and parenteral groups, significant difference in log rank test (P<0.002). Enteral anti-tuberculosis regimen may contribute to survival of smear positive pulmonary tuberculosis requiring mechanical ventilator.