Drug management of TB in the intensive care setting: an international multicentre study

Tiberi S.; Akkerman O.; Sotgiu G.; Saderi L.; Kunst H.; Carvalho A.C.C.; Muñoz-Torrico M.; Lui G.C.-Y.; Rendon A.; Cordeiro dos Santos M.; Rosso R.G.; Mendes I.C.; Mendoza A.; Borges M.C.; Kritski A.; Marçôa R.; Vieira M.A.; Hernandez-Cardenas C.M.; Rahman A.; Barrett J.; Shah K.; Wagrell L.; Johnson E.; Hall J.; Sabir N.; Lynn W.; Zolfaghari P.; Duarte R.; Davies Forsman L.; Whittington A.; Martin-Lazaro J.F.; White V.; Chen C.; Gray A.; Brown M.; Alffenaar J.-W.C.; Bruchfeld J.; Centis R.; D’Ambrosio L.; Ruslami R.; Kerstjens H.A.M.; Zumla A.; Ambrosino N.; Migliori G.B.; Tiberi S. · International Journal of Tuberculosis and Lung Disease (2025) · DOI: 10.5588/ijtld.24.0597

Resumen

BACKGROUND: Individuals requiring admission to an intensive care unit (ICU) due to TB have complex clinical presentations and high mortality rates. There is a clear knowledge gap on how to optimally manage treatment. OBJECTIVE: To evaluate the treatment outcomes of TB patients in ICU and explore the potential benefits of intravenous (IV) TB treatment regimens. METHODS: A retrospective observational multicentre study was conducted by the International Severe TB and Rehabilitation Working Group of the Global Tuberculosis Network (GTN). The study included TB patients aged .15 years admitted to ICUs in Europe, Asia and Latin America from January 1, 2005 to December 31, 2018. Data on demographics, microbiology, clinical information and treatment outcomes were collected and analysed. RESULTS: The study enrolled 434 cases. Over half were sputum smear-positive and 85.7% were culture-positive. Most required invasive mechanical ventilation, vasopressor support and steroids. Only 48.4% had TB medications initiated before or during ICU admission. The overall mortality rate was 54.8%, with 33.4% achieving treatment success. IV anti-TB drugs were administered to 43% of participants, with levofloxacin and amikacin being the most used. IV treatment longer than 10 days was associated with better outcomes. Individuals receiving IV rifampicin had a lower mortality rate (35.7%) compared to those who did not receive it (51.7%), p-value¼ 0.05. CONCLUSIONS: High mortality rates in ICU indicate the need for improved management strategies. The use of IV TB drugs, especially IV rifampicin, show potential benefit, suggesting the need for further prospective studies. Early screening and standardized treatment protocols could improve patient outcomes in high-incidence areas.