Is the delay in diagnosis of pulmonary tuberculosis related to exposure to fluoroquinolones or any antibiotic?

Wang, M; Fitzgerald, J M; Richardson, Kathryn; Marra, Carlo; Cook, Victoria; Hájek, Jan; Elwood, R. Kevin; Bowie, W R; Marra, Fawziah

doi:10.5588/ijtld.10.0734

Cited by 26 publications

(17 citation statements)

References 11 publications

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“…A population-based cohort study in Canada between 1997 and 2006 reported that previous treatments with any antibiotics, not only FQ, are associated with delayed TB diagnosis [37]. Use of β-lactams is probably not a confounding factor in the survival analysis, however, because all of the patients in this study received β-lactams on admission.…”

Section: Discussionmentioning

confidence: 96%

Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia

et al. 2012

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IntroductionEmpirical use of fluoroquinolones may delay the initiation of appropriate therapy for tuberculosis (TB). This study aimed to evaluate the impact of empirical fluoroquinolone use on the survival of patients with pulmonary TB that mimicked severe community-acquired pneumonia (CAP) requiring intensive care.MethodsPatients aged >18 years with culture-confirmed pulmonary TB who presented as severe CAP and were admitted to the ICU were divided into fluoroquinolone (FQ) and nonfluoroquinolone (non-FQ) groups based on the type of empirical antibiotics used. Those patients with previous anti-TB treatment or those who died within 3 days of hospitalization were excluded. The primary end point was 100-day survival.ResultsOf the 77 patients identified, 43 (56%) were in the FQ group and 34 (44%) were in the non-FQ group. The two groups had no statistically significant difference in co-morbidities (95% vs. 97%, P > 0.99) and Acute Physiology and Chronic Health Evaluation (APACHE) II scores (21.2 ± 7.1 vs. 22.5 ± 7.5, P = 0.46) on ICU admission. Overall, 91% and 82% of patients in the FQ and non-FQ groups, respectively, had sputum examinations for TB within 1 week of admission (P = 0.46), and results were positive in 7% and 15% (P = 0.47), respectively. For both groups, 29% received appropriate anti-TB therapy within 2 weeks after ICU admission. The 100-day mortality rate was 40% and 68% for the FQ and non-FQ groups, respectively (P = 0.02). By Cox regression analysis, APACHE score <20, no bacteremia during the ICU stay, and empirical fluoroquinolone use were independently associated with survival.ConclusionEmpirical use of fluoroquinolones may improve the survival of ICU patients admitted for pulmonary TB mimicking severe CAP.

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Section: Discussionmentioning

confidence: 96%

Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia

et al. 2012

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“…The availability of rapid and accurate diagnostic tests such as the Xpert ® MTB/RIF assay (Cepheid, Sunnyvale, CA, USA), which was endorsed by the WHO in 2010 as part of TB case-finding activities for PLHIV, increases the TB diagnostic yield by 45%, and its use is currently being expanded in Kenya in more health facilities, which would increase TB diagnosis and reduce delays. 26–29 To further optimize TB diagnosis among PLHIV, clinicians need to be trained and mentored, laboratory capacity needs to be enhanced with a wider and more efficient network of TB diagnostic testing, diagnostic tests need to be made accessible and affordable and documentation/feedback of results needs to be improved.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009

Burmen

Modi

Cavanaugh

et al. 2016

int j tuberc lung dis

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SUMMARY SETTING Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya. OBJECTIVE To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding. DESIGN Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year. Factors associated with evidence of TB diagnostic evaluation among symptomatic PLHIV were assessed. RESULTS Of 1020 patients included in the analysis, 995 (98%) were screened for TB at enrolment and 613 (62%) reported TB symptoms. Ninety-six (16%) patients with symptoms had evidence of referral for TB diagnostic evaluation, including patients at large clinics, those with advanced HIV disease and those reporting multiple TB symptoms. Among the 43 (45%) with documented evaluation results, 26 (60%) were diagnosed with TB. CONCLUSION Although most PLHIV were screened for TB, very few underwent an evaluation, and the proportion diagnosed with TB was very low. Efforts to improve TB screening should focus on standardizing the intensified case finding algorithm and linkage to, and adequate infrastructure for, TB diagnostic evaluation.

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“…Our findings are consistent with recent reports that have also demonstrated that any antibiotic use, regardless of class, is associated with longer TB diagnostic delays. 14-16 The basis for this delay is poorly understood; however, the delay is likely related to the time spent waiting for a clinical response to the antibiotic. 16 …”

Section: Discussionmentioning

confidence: 99%

Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia

Rabin¹,

Kuchukhidze²,

Sanikidze³

et al. 2013

int j tuberc lung dis

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SETTING Georgia has a high burden of tuberculosis (TB), including multidrug-resistant TB. Enhancing early diagnosis of TB is a priority to reduce transmission. OBJECTIVE To quantify delays in TB diagnosis and identify risk factors for delay in the country of Georgia. DESIGN In a cross-sectional study, persons with newly diagnosed, culture-confirmed pulmonary TB were interviewed within 2 months of diagnosis and medical and laboratory records were abstracted. RESULTS Among 247 persons enrolled, the mean and median total TB diagnostic delay was respectively 89.9 and 59.5 days. The mean and median patient delay was 56.2 and 23.5 days, while health care system delay was 33.7 and 14.0 days. In multivariable analysis, receipt of a medication prior to TB diagnosis was associated with increased overall diagnostic delay (adjusted odds ratio [aOR] 2.28, 95%CI 1.09–4.79); antibiotic use prior to diagnosis increased the risk of prolonged health care delay (aOR 4.16, 95%CI 1.97–8.79). TB cases who had increased patient-related diagnostic delay were less likely to have prolonged health care diagnostic delay (aOR 0.38, 95%CI 0.19–0.74). CONCLUSION Prolonged delays in detecting TB are common in Georgia. Interventions addressing the misuse of antibiotics and targeting groups at risk for prolonged delay are warranted to reduce diagnostic delays and enhance TB control.

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Is the delay in diagnosis of pulmonary tuberculosis related to exposure to fluoroquinolones or any antibiotic?

Abstract: Previous treatment with any antibiotic, and not only a FQ, is associated with a delay in TB diagnosis.

Cited by 26 publications

References 11 publications

Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia

Empirical use of fluoroquinolones improves the survival of critically ill patients with tuberculosis mimicking severe pneumonia

Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009

Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia

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