Programa de Pós-Graduação em Ciências Pneumológicas da, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Trop Med Int Health. 2021 Jan;26(1):111-114. doi: 10.1111/tmi.13511. Epub 2020 Nov 27.
Adequate anti-tuberculosis (TB) treatment is an important factor that can affect the patient's outcome. Higher mortality is found in patients who do not receive optimal treatment that includes isoniazid and rifampicin. The objective of this study is to evaluate the association of use of alternative TB treatment regimens (without rifampicin and isoniazid) and mortality among patients requiring intensive care.
Retrospective cohort study, from January 2010 to December 2018. Patients aged > 18 years with a TB diagnosis, admitted to the ICU of a general, tertiary care, university-affiliated hospital (Hospital de Clínicas de Porto Alegre - HCPA) were included. Data on TB treatment used and outcomes of treatment were collected.
462 patients met the inclusion criteria and were included in the analysis; 284 used the usual treatment regimen (rifampicin, isoniazid, pyrazinamide and ethambutol - all orally), and 178 used alternative treatment regimens (IV levofloxacin plus oral ethambutol plus IM streptomycin or IV amikacin, without rifampicin and isoniazid). The mortality was higher among users of alternative treatment regimens (63.5%) than among usual treatment regimen users (51.4%) (P = 0.011). In a multivariate analysis, age, albumin and death were independently associated with alternative treatment regimens use.
TB programmes in which IV rifampicin is not widely available should consider including it, especially for critically ill TB patients, for whom there may be improved survival.
充分的抗结核（TB）治疗是影响患者结局的重要因素。未接受包含异烟肼和利福平的最佳治疗的患者死亡率更高。本研究的目的是评估在需要重症监护的患者中，使用替代 TB 治疗方案（不含利福平异烟肼）与死亡率之间的关系。
回顾性队列研究，时间为 2010 年 1 月至 2018 年 12 月。纳入年龄＞18 岁，诊断为结核病，入住综合三级护理大学附属医院（阿雷格里港临床医院 - HCPA）重症监护病房的患者。收集有关 TB 治疗方法和治疗结局的数据。
462 名符合纳入标准的患者被纳入分析；284 名患者使用常规治疗方案（利福平、异烟肼、吡嗪酰胺和乙胺丁醇 - 均口服），178 名患者使用替代治疗方案（IV 左氧氟沙星+口服乙胺丁醇+IM 链霉素或 IV 阿米卡星，不含利福平异烟肼）。替代治疗方案使用者的死亡率（63.5%）高于常规治疗方案使用者（51.4%）（P=0.011）。在多变量分析中，年龄、白蛋白和死亡与替代治疗方案的使用独立相关。
不广泛提供 IV 利福平的 TB 项目应考虑将其纳入其中，尤其是对患有严重结核病的患者，因为这可能会提高其生存率。
