title: Improved survival in patients with severe tuberculosis after exposure to fluoroquinolones.
abstract: BACKGROUND
  The clinical impact of prior exposure to antibiotics on patients with tuberculosis (TB) is largely unknown. This study investigated the survival of patients with severe TB after exposure to a variety of antibiotics.
  
  
  METHODS
  A retrospective cohort study was conducted in TB patients with prior exposure to fluoroquinolones (FQs) (FQ group), to third-generation cephalosporins (CEPH group), and to third-generation penicillins (PCN group). To understand the impact of monotherapy with antibiotics on survival, patients with prior exposure to only moxifloxacin, ceftriaxone, or piperacillin were investigated.
  
  
  RESULTS
  Patients in the FQ group (N= 401) had a significantly higher survival rate (82.5%) than patients in the CEPH (N = 210) and PCN (N = 172) groups (67.6% and 62.8%, respectively; both p < 0.0001) at 180 d after TB diagnosis. Adjusted odds ratio (AOR) logistic regression analysis demonstrated that patients in the FQ group had significantly more favourable outcomes than those in the CEPH and PCN groups in terms of intensive care unit (ICU) admission rate (versus CEPH cohort: AOR, 1.70; 95% CI: 1.16-2.50; p = 0.0067, versus PCN cohort: AOR, 3.58; 95% CI: 2.42-5.29; both p < 0.0001), mechanical ventilation rate (versus CEPH cohort: AOR, 1.70; 95% CI: 1.09-2.66; p = 0.0205, versus PCN cohort: AOR, 3.92; 95% CI: 2.54-6.05; both p < 0.0001), and acute respiratory failure rate (versus CEPH cohort: AOR, 1.62; 95% CI: 1.07-2.45; p = 0.0223, versus PCN cohort: AOR, 4.29; 95% CI: 2.86-6.43; both p < 0.0001). TB patients with prior exposure to moxifloxacin (N = 198) had a significantly higher survival rate (85.9%) than that of patients with exposure to ceftriaxone (N = 119) and piperacillin (N = 172) monotherapy (survival rates: 69.8% and 62.8%, respectively; both p < 0.001).
  
  
  CONCLUSIONS
  TB patients with prior exposure to FQs had more favourable outcomes compared with patients who had prior exposure to third-generation cephalosporins or third-generation penicillins. This study provides new insights into the impact of previous exposure to FQs on the survival of TB patients.
authors.affiliation: a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;|b Department of General Education , Chia Nan University of Pharmacy and Science , Tainan , Taiwan ;
authors.forename: Shyh-Ren
authors.initials: SR
authors.lastname: Chiang
authors.affiliation: a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;|b Department of General Education , Chia Nan University of Pharmacy and Science , Tainan , Taiwan ;
authors.forename: Jiunn-Min
authors.initials: JM
authors.lastname: Shieh
authors.affiliation: c Department of Internal Medicine , En Chu Kong Hospital , New Taipei City , Taiwan ;
authors.forename: Chung-Hua
authors.initials: CH
authors.lastname: Chen
authors.affiliation: d Departments of Respiratory Care Section , Chi Mei Medical Center , Tainan , Taiwan ;|f College of Health Sciences , Chang Jung Christian University , Tainan , Taiwan ;
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Hsing
authors.affiliation: e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan ;|g Department of Hospital and Health Care Administration , Chia Nan University of Pharmacy and Science , Tainan , Taiwan ;
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Wen
authors.affiliation: e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan ;
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: a Department of Internal Medicine , Chi Mei Medical Center , Tainan , Taiwan ;|h Department of Safety Health and Environment , Chung Hwa University of Medical Technology , Tainan , Taiwan ;|i Department of Medicine , National Defense Medical Center , Taipei , Taiwan ;
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.affiliation: e Department of Medical Research , Chi Mei Medical Center , Tainan , Taiwan ;|j Department of Internal Medicine , Chi Mei Medical Center-Liou Ying , Tainan City , Taiwan.
authors.forename: Yin-Ching
authors.initials: YC
authors.lastname: Chuang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000627:therapeutic use; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077266:Moxifloxacin; D010878:Piperacillin / Q000627:therapeutic use; D012189:Retrospective Studies; D016019:Survival Analysis; D014376:Tuberculosis / Q000401:mortality*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D002443:Ceftriaxone; D000077266:Moxifloxacin; D010878:Piperacillin
keywords: Antibiotics; fluoroquinolone; outcomes; population-based cohort study; tuberculosis