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  • In a total of 33,103 hospitalized CAP cases, there were 30,018 (90.7%) bacterial CAP, 2,566 (7.8%) tuberculosis and 519 (1.6%) coinfection cases
  • Bacterial-tuberculosis coinfection was associated with higher severity of illness, prevalence of sepsis, need for invasive organ support and increased mortality risk compared to TB or bacterial CAP alone (Figure 2)
  • Coinfection was independently associated with higher mortality risk with an odds ratio of 2.43 using bacterial CAP as reference

Clinical Outcomes of Community Acquired Pneumonia from Bacterial and Mycobacterium Tuberculosis Coinfection

Chang Lok Ching1, Jack Zhenhe Zhang1, Lowell Ling1

1 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China

Methods

  • Population-based retrospective cohort study on all adult hospitalizations for CAP in Hong Kong between April 1, 2009 - March 31, 2019
  • Cohort definition:
    1. Bacterial CAP: positive bacterial culture but negative Mycobacterium tuberculosis (MTB) results
    2. CAP from tuberculosis: positive MTB results but negative bacterial culture
    3. CAP from bacterial-tuberculosis coinfection: concurrent positive results from bacterial culture and MTB tests
  • Determine the characteristics and clinical outcomes of bacterial-tuberculosis coinfection
  • Evaluate the attributive mortality risks among bacterial infected community acquired pneumonia (CAP), tuberculosis and bacterial-tuberculosis coinfection patients

Objectives

Results

Figure 1. Case fatality rate of bacterial-tuberculosis coinfection

Case fatality rate of community acquired pneumonia (CAP) from bacterial, tuberculosis or bacterial-tuberculosis coinfection across two periods of 2009-2013 and 2014-2018.

  • Tuberculosis has a high prevalence and mortality rate
  • Coinfection of bacterial pathogens in tuberculosis may be associated with increased mortality
  • Little is known about epidemiology of bacterial-tuberculosis coinfection

Introduction

Figure 2. Severity of illness and mortality rate

(A) Proportion of community acquired pneumonia (CAP) caused by bacterial, tuberculosis or bacterial-tuberculosis coinfection that required renal replacement therapy (RRT), vasopressors and mechanical ventilation (MV) during hospital stay. (B) Distribution of delta sequential organ failure assessment (ΔSOFA) score amongst different types of CAP. (C) Case fatality rate according to severity of illness as assessed by ΔSOFA.

Conclusions

  • Bacterial-tuberculosis coinfection is rare in patients hospitalized for bacterial or tuberculosis CAP
  • Compared to tuberculosis or bacterial CAP alone, coinfection is associated with higher severity of illness and mortality risk