PURPOSE: To describe a group of patients with septic shock caused by M. Tuberculosis and compare their outcomes to those of patients with septic shock caused by other microorganisms.
METHODS: Data was extracted from a multicenter database with information from the records of 2731 patients with septic shock. Patients with septic shock caused by M. Tuberculosis were identified by positive blood or multi-site cultures.
RESULTS: A total of 2731 patients with septic shock were studied. Eleven patients (0.4%) had septic shock caused by M.Tuberculosis (MTB group). In the MTB group, the mean age was 44.2 ([+ or -] 19.5) years, mean APACHE II score was 26 ([+ or -] 8), 36% were males and 64% were females. Comorbid conditions included; alcohol use 54%, non-HIV immunosupresive diseases 36.4%, and diabetes mellitus 18.2%. None of these patients had documented HIV. Overall mortality in the MTB group was 81.8 %, and mean length of stay in the ICU was 12.7([+ or -] 17.1) days. Inapropriate initial antimicrobial coverage based on culture results was given to five patients (45.5%) in the MTB group. When compared to patients with septic shock caused by other microorganism (OTH group), patients in MTB group were younger (44.27([+ or -] 19.5) years vs 62.66 ([+ or -] 16.4)) years p = 0.0002), and more likely to have alcohol use as a comorbidity (54.4% vs 13.8 %, p= 0.0013). Patients in the MTB group were more likely to receive inappropriate initial antimicrobial therapy than patients in the OTH group (45.5% vs 18.6%, p=0.0039). Patients in the MTB group had a higher mean ICU LOS (12.21 days vs 8.1 days), had a higher overall mortality (81.8% vs 56.2% , p = 0.12), and were more likely to develop hepatic failure (p 0.0039).
CONCLUSION: M. Tuberculosis is an uncommon cause of septic shock. However, when it occurs it is associated with increased morbidity and mortality and a significant delay in institution of appropriate antituberculous treatment.
CLINICAL IMPLICATIONS: Mycobacterium Tuberculosis should be thought of as a possible cause for septic shock in apropriate clinical situations.
DISCLOSURE: Raquel Nahra, None.
Raquel Nahra MD * Sergio L. Zanotti-Cavazzoni MD Anand Kumar MD Cooper University Hospital, Camden, NJ
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group