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Original Research: Critical Care |

Mycobacterium tuberculosis Septic ShockMycobacterium tuberculosis Septic Shock

Shravan Kethireddy, MD; R. Bruce Light, MD; Yazdan Mirzanejad, MD; Dennis Maki, MD; Yaseen Arabi, MD; Stephen Lapinsky, MD; David Simon, MD; Aseem Kumar, PhD; Joseph E. Parrillo, MD, FCCP; Anand Kumar, MD; for the Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Group*
Author and Funding Information

From the Section of Critical Care Medicine (Drs Kethireddy, Light, and Anand Kumar), and the Section of Infectious Diseases (Drs Light and Anand Kumar), University of Manitoba, Winnipeg, MB, Canada; Surrey Memorial Hospital (Dr Mirzanejad), Surrey, BC, Canada; the Section of Critical Care Medicine (Dr Lapinsky), University of Toronto, Toronto, ON, Canada; Laurentian University (Dr Aseem Kumar), Sudbury, ON, Canada; the University of Wisconsin Hospital and Clinics (Dr Maki), Madison, WI; Rush University (Dr Simon), Chicago, IL; Hackensack University Medical Center (Dr Parrillo), Hackensack, NJ; and King Saud Bin Abdulaziz University for Health Sciences (Dr Arabi), Riyadh, Saudi Arabia.

Correspondence to: Anand Kumar, MD, Section of Critical Care Medicine, Health Sciences Centre, 700 William Ave, JJ399, Winnipeg, MB, R3E-0Z3, Canada; e-mail: akumar61@yahoo.com


* A complete list of participants is located in e-Appendix 1.

Funding/Support: This study was supported by unrestricted research grants to Anand Kumar from Eli-Lilly and Company; Pfizer, Inc; Bayer; Astellas Pharma; Merck & Co, Inc; the Manitoba Health Research Council; the Health Sciences Centre (Winnipeg) Foundation; the Innovations and Opportunities Foundation (Winnipeg); and the Deacon Foundation (Winnipeg).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):474-482. doi:10.1378/chest.12-1286
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Background:  Septic shock due to Mycobacterium tuberculosis (MTB) is an uncommon but well-recognized clinical syndrome. The objective of this study was to describe the unique clinical characteristics, epidemiologic risk factors, and covariates of survival of patients with MTB septic shock in comparison with other bacterial septic shock.

Methods:  A retrospective nested cohort study was conducted of patients given a diagnosis of MTB septic shock derived from a trinational, 8,670-patient database of patients with septic shock between 1996 and 2007.

Results:  In the database, 53 patients had been given a diagnosis of MTB shock compared with 5,419 with septic shock associated with isolation of more common bacterial pathogens. Patients with MTB and other bacterial septic shock had in-hospital mortality rates of 79.2% and 49.7%, respectively (P < .0001). Of the cases of MTB shock, all but five patients had recognized respiratory tract involvement. Fifty-five percent of patients (29 of 53) were documented (by direct culture or stain) as having disseminated extrapulmonary involvement. Inappropriate and appropriate initial empirical therapy was delivered in 28 patients (52.8%) and 25 patients (47.2%); survival was 7.1% and 36.0%, respectively (P = .0114). Ten patients (18.9%) did not receive anti-MTB therapy; all died. The median time to appropriate antimicrobial therapy for MTB septic shock was 31.0 h (interquartile range, 18.9-71.9 h). Only 11 patients received anti-MTB therapy within 24 h of documentation of hypotension; six of these (54.5%) survived. Only one of 21 patients (4.8%) who started anti-MTB therapy after 24 h survived (P = .0003 vs < 24 h). Survival differences between these time intervals are not significantly different from those seen with bacterial septic shock due to more common bacterial pathogens.

Conclusions:  MTB septic shock behaves similarly to bacterial septic shock. As with bacterial septic shock, early appropriate antimicrobial therapy appears to improve mortality.

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