肺结核合并肺炎克雷伯菌感染重症肺结核

Background Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens leading to pulmonary tuberculosis (PTB) co-infection, but the data of co-infections is scarce. This research aimed to study the clinical and microbiological characteristics of K. pneumoniae co-infections in pulmonary tuberculosis cases. Methods Clinical manifestations and examination results of PTB cases co-infected by K. pneumoniae were retrospectively collected from the medical record database of a tertiary teaching hospital in China between November 2019 and October 2021. The K. pneumoniae strains isolated from the patients were sent for whole-genome sequencing. Statistical analyses were conducted using Stata v.14.0. Results A total of 80 strains were collected from 76 PTB patients with K. pneumoniae co-infections (two strains were isolated from each of the four patients at different time points), including 37 primary and 39 retreated TB cases. Among these, 29 (36.3%) of the K. pneumoniae isolates were extended-spectrum β-lactamase (ESBL)-producing strains, and seven (8.8%) were determined as carbapenem-resistant Enterobacteriaceae (CRE) strains. We found that patients in the multidrug resistance (MDR)-group received more respiratory support than the non-MDR group (40.6% vs 18.2%, P= 0.031) and possessed higher elevated C-reactive protein (62.6% vs 41.8%, P=0.008) and lower haemoglobin (87.5% vs 47.7%, P=0.001). We found that 80.3% (61/76) patients had lung lesions and 57.8% (44/76) patients were immunocompromised within one month. The most common K. pneumoniae strain sequence type was ST23 (15%), followed by ST15 (12.5%) and ST273 (7.5%). Among the strains, 26.25% were classically hypervirulent K1/K2 K. pneumoniae, and all carried salmochelin and rmpA. Conclusion This study demonstrated the important clinical features, phenotypic and genomic characteristics of isolated strains of PTB patients with K. pneumoniae co-infection. These data suggested a special attention for multidrug resistant K. pneumoniae infections with more obvious inflammatory responses which calls for more respiratory support and timely clinical management.

  Klebsiella pneumoniae and Mycobacterium tuberculosis coinfection is one of the most lethal combinations with high mortality specially if there is delay in diagnosis and proper management. Patients with uncontrolled diabetes mellitus are prone to develop this type of serious infection.There is a considerable overlap in the clinical presentation of these critical pulmonary infections hence there is need for a high index of clinical suspicion, appropriate judicious investigations, and promt management to improve survivality. Here, we have presented Mycobacterium tuberculosis and Klebsiella pneumonia co-infection presenting as cough, chest pain, and shortness of breath in an elderly male with multiple co-morbidities, like uncontrolled diabetes mellitus, hypertension, prosthetic aortic valve in situ (for aortic stenosis)& previous history of ishchaemic stroke. This combination is rare and to the best of our knowledge not reported in the literature from Bangladesh. Bangladesh J Medicine 2022; 33: 52-57        

BackgroundCambodia, a lower middle-income country of about 16 million individuals in southeast Asia, endures a high burden of both tuberculosis and other lower respiratory infections. Differentiating tuberculosis from other causes of respiratory infection has important clinical implications yet may be challenging to accomplish in the absence of diagnostic microbiology facilities. Furthermore, co-infection of tuberculosis with other bacterial lower respiratory infections may occur. The objective of this study was to determine the prevalence and etiologies of tuberculosis and other bacterial co-infection and to analyze the clinical and radiographic characteristics of patients presenting with respiratory infection to a provincial referral hospital in Cambodia.MethodsWe performed a retrospective, cross-sectional analysis of laboratory and clinical data, on patients presenting with respiratory symptoms to a chest clinic of a 260-bed provincial referral hospital in Cambodia. We analyzed mycobacterial and bacterial sputum test results, and demographics, medical history and chest radiography.ResultsAmong 137 patients whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, the median age was 52 years, 54% were male, 3% had HIV infection, and 26% were current smokers. Nearly all had chronic respiratory symptoms (> 96%) and abnormal chest radiographs (87%). Sputum testing was positive for tuberculosis in 40 patients (30%) and for bacteria in 60 patients (44%); 13 had tuberculosis and bacterial co-infection (9% overall; 33% of tuberculosis patients). Clinical characteristics were generally similar across pulmonary infection types, although co-infection was identified in 43% of patients with one or more cavitary lesions on chest radiography. Among those with bacterial growth on sputum culture, Gram negative bacilli (Klebsiella and Pseudomonas spp.) were the most commonly isolated.ConclusionsAmong patients with symptoms of respiratory infections whose treating clinicians ordered sputum testing for tuberculosis and other bacteria, 9% of all patients and 33% of tuberculosis patients had tuberculosis and bacterial co-infection. Greater availability of microbiologic diagnostics for pulmonary tuberculosis and bacterial infection is critical to ensure appropriate diagnosis and management.

Background Captive Asiatic black bears (Ursus thibetanus) may face increased health risks under conditions of stress or close human contact, including vulnerability to infectious diseases. Bacterial pathogens such as Mycobacterium tuberculosis complex and Klebsiella pneumoniae pose health risks in captive settings. However, co-infections involving these pathogens have not been previously reported in captive Asiatic black bears. Case report Two male Asiatic black bears (Ursus thibetanus), aged 2 and 3 years, developed persistent diarrhea, which improved temporarily after penicillin and cephalosporin treatment but relapsed shortly after. Despite ongoing therapy, both showed progressive weight loss, lethargy, and depression. Five days before death, acute respiratory signs, including fever, tachypnea, and coughing, appeared, followed by rapid decline. Necropsy revealed multisystemic lesions. Histopathological examination, Ziehl–Neelsen and Gram staining revealed acid-fast bacilli and Gram-negative bacilli intralesionally, PCR amplification and sequencing of DNA extracted from lung tissue identified carbapenem-resistant hypervirulent Klebsiella pneumoniae strains carrying multiple virulence and resistance genes, as well as a Mycobacterium spp. agent of the M. tuberculosis complex. Conclusion This case underscores the risks of fatal co-infections between an agent of the Mycobacterium tuberculosis complex and carbapenem-resistant hypervirulent Klebsiella pneumoniae in captive wildlife. Integrated diagnostics, timely detection, and prudent antibiotic stewardship are essential, but the absence of diagnostic standards could delay recognition. Establishing systematic criteria is urgently needed to improve treatment and long-term health management. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-026-05344-8.

Tuberculosis (TB) is a major public health issue in India. Although dual infection with tuberculosis and bacteria/fungi has been reported in immunocompromised patients, their co-occurrence in individuals with preserved immunity may complicate the clinical presentation, leading to inadequate treatment and unsatisfactory outcomes. In patients with pulmonary tuberculosis, the occurrence of tubercular lesions in atypical locations may further confound the clinical picture if only one of the pathogens is isolated, initially leading to a suboptimal therapeutic response. A strong index of suspicion and additional diagnostic testing may be required for diagnosis and treatment of the second infection. We report three unusual cases of concurrent tubercular and bacterial infection, of which two are pulmonary and one is extrapulmonary.

BACKGROUND This study aims to investigate the clinical characteristics associated with concurrent Klebsiella pneu-moniae (K. pneumoniae) infection in hospitalized patients with severe pulmonary tuberculosis. METHODS A retrospective study was conducted on hospitalized severe pulmonary tuberculosis patients between January 2019 and December 2020. Among the 487 patients with severe pulmonary tuberculosis, a positive sputum culture for K. pneumoniae was reported in 76 patients (15.6%, 61 males and 15 females). RESULTS Among these patients, 27 (35.5%) and 49 (64.5%) patients were with and without K. pneumoniae infection, respectively. Compared to patients without K. pneumoniae infection, patients with K. pneumoniae infection had higher mortality (16.3% vs. 40.7%, p = 0.02), and lower inhibitory/cytotoxic CD8 count (24.2 ± 9.9 vs. 17.8 ± 8.0, p = 0.02), complement C4 (0.3 ± 0.1 vs. 0.2 ± 0.1, p = 0.01), and retinol-binding protein level (32.2 ± 22.2 vs. 22.4 ± 11.8, p = 0.02). Furthermore, the acute Physiology and Chronic Health Evaluation II score was associated with the K. pneumoniae infection in severe pulmonary tuberculosis patients. CONCLUSIONS It can be concluded that a significant number of severe pulmonary tuberculosis patients can have concurrent K. pneumoniae infection. Immunity, nutritional status, and disease severity are associated with the concurrent infection of K. pneumoniae in these patients.

Tuberculosis (TB) continues to be a major global health burden, and co-infection with other pathogens further complicates the diagnosis and treatment of this infectious disease. The present retrospective study aimed to evaluate the clinical utility of nanopore sequencing in identifying co-infection caused by Mycobacterium tuberculosis (M.tb) and other pathogens. Patients with M.tb co-infection from December 2021 to March 2023 at the Jiangxi Provincial Chest Hospital were retrospectively studied. Data were collected including demographics, symptoms, imaging findings, pathogen diagnosis tests, and treatment history. Pathogen tests involved culture, AFB smear, Xpert MTB/RIF, and nanopore sequencing. The enrolled patients included 20 M.tb cases and three nontuberculous mycobacteria (NTM) cases co-infected with other pathogens. Common clinical symptoms included cough (47.83%), expectoration (34.78%), and asthma (17.39%). Radiological examinations showed typical features of pulmonary tuberculosis, including nodules (73.91%), cord-like shadows (34.78%), cavities (34.78%), and destroyed lung manifestations (17.39%). Nanopore sequencing identified M.tb in a significant majority of the cases (86.96%), outperforming traditional culture tests (39.13%), acid-fast bacilli (AFB) tests (27.27%), and Xpert MTB/RIF (53.84%) tests. Notably, nanopore sequencing revealed that M.tb was frequently co-infected with Candida albicans, Klebsiella pneumoniae, and Mycobacterium abscessus. Three specific cases of co-infection with distinct diagnosis and treatment characteristics were presented in detail. They illustrated the complexity of TB co-infection management and the potential of nanopore sequencing for accurate diagnosis and informing the tailored therapeutic approaches. Nanopore sequencing-based metagenomics method can help clinicians to identify TB co-infection patterns and formulate a rational drug regimen in time.

ABSTRACT The prevalence of multidrug-resistant Klebsiella pneumoniae (MDR-KP) is rising globally. The aim of this study was to investigate the epidemiology, risk factors, and clinical outcomes of MDR-KP coinfections with multiple microbes and infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) among patients in a tertiary hospital in China and to establish an individualized linear prediction model. In this retrospective study, patients admitted from January 2021 to March 2024 with a diagnosis of MDR-KP infection were included. We recorded demographics, comorbidities, laboratory indicators, therapeutic interventions, antimicrobial susceptibility tests (ASTs), and analyzed clinical outcomes. Logistic regression models were employed to evaluate the risk factors associated with MDR-KP coinfections and infections with CRKP. A total of 164 patients with MDR-KP infection were included. Of these patients, 78 (47.6%) were infected with MDR-KP only, and 86 (52.4%) were coinfected with other microbes; 115 (70.1%) were infected with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP), and 49 (29.9%) were infected with CRKP. The most common source of infection among patients with MDR-KP infection was the respiratory tract (96/164, 58.5%), followed by the urinary tract (31/164, 18.9%). Multivariate logistic regression analysis showed that nasogastric catheters (odds ratio [OR], 5.351; 95% confidence inteval [CI], 1.437–19.926, P = 0.012), as well as venous and arterial catheters (OR, 5.182; 95% CI, 1.272–21.113, P = 0.022), were independent risk factors for coinfection. The total risk score for all factors was 143.3, with a predicted risk rate ranging from 0.25 to 0.85. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for predicting coinfection based on the total risk score was 0.773 (95% CI: 0.7054–0.8405). Tracheostomy (OR, 4.673; 95% CI, 1.153–18.937, P = 0.031) and fiberoptic bronchoscopy (OR, 4.041; 95% CI, 1.305–12.516, P = 0.015) were independent risk factors for infection with CRKP. The total risk score for all factors was 193.9, with a predicted risk rate ranging from 0.15 to 0.85. In the ROC analysis, the AUC for predicting CRKP using the total risk score was 0.752 (95% CI: 0.6739–0.8306). Analysis of the calibration curve indicated good agreement between the observed and predicted values. The log-rank test was used to compare all-cause mortality between the two groups, and 30-day mortality was higher in the coinfected group than that in the MDR-KP alone group (P = 0.03). There was no significant difference in 30-day mortality between the CRKP and ESBL-KP groups (P = 0.09). This study successfully established a predictive model based on risk factors, which has good predictive value for both patients with coinfections and those with CRKP. Coinfections and CRKP infections were significantly associated with increased overall mortality, elevated healthcare costs, and poor prognosis in patients. These findings provided a basis for further clinical research and optimization of management strategies for MDR-KP coinfections and CRKP infections. IMPORTANCE Coinfections and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections significantly increased morbidity and economic burden, leading to longer intensive care unit (ICU) stays and poorer prognoses. Coinfection may also lead to a higher 30-day mortality rate. Patients suffering from multidrug-resistant Klebsiella pneumoniae (MDR-KP) used two or more antibiotics for infection control, but the therapeutic outcomes remained suboptimal. In order to reverse the rising trend in mortality rate associated with coinfection and CRKP infection, certain measures need to be taken: (i) develop stricter protocols for terminal cleaning of rooms (especially ICUs), cleaning of equipment (such as bronchoscopes) and hand hygiene; (ii) conduct antimicrobial resistance gene testing in the healthcare environment and implement antimicrobial stewardship to optimize antibiotic consumption and reduce the emergence and spread of multidrug-resistant organisms. Coinfections and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections significantly increased morbidity and economic burden, leading to longer intensive care unit (ICU) stays and poorer prognoses. Coinfection may also lead to a higher 30-day mortality rate. Patients suffering from multidrug-resistant Klebsiella pneumoniae (MDR-KP) used two or more antibiotics for infection control, but the therapeutic outcomes remained suboptimal. In order to reverse the rising trend in mortality rate associated with coinfection and CRKP infection, certain measures need to be taken: (i) develop stricter protocols for terminal cleaning of rooms (especially ICUs), cleaning of equipment (such as bronchoscopes) and hand hygiene; (ii) conduct antimicrobial resistance gene testing in the healthcare environment and implement antimicrobial stewardship to optimize antibiotic consumption and reduce the emergence and spread of multidrug-resistant organisms.

Tuberculosis (TB) is a chronic condition that weakens the immune system, causes structural changes in the lungs, and can lead to infections by other bacterial pathogens. Very few studies have been done to understand the magnitude of co-infection with other bacterial pathogens, so this study was conducted to understand the co-infection pattern and burden. A total of 174 microbiologically confirmed pulmonary TB patients' samples, identified by cartridge-based nucleic acid amplification test, were further tested for other bacterial pathogens by culture over a period of five months from May 2023 to September 2023. The isolates' identification and drug susceptibility were performed using the VITEK 2 system (bioMérieux, Marcy-l'Étoile, France). Of the 174 pulmonary samples tested, 19 samples grew a significant amount of other bacterial pathogens, making the prevalence 10.91% (19/174). Among the pulmonary samples tested, 54.59% were sputum, 38.5% were bronchoalveolar lavage, and 6.89% were endotracheal aspirate. Additionally, 70.11% of the patients tested were in the age group of 19-60 years. Of the patients who had co-infection, 94.73% (18/19) were male. The most common bacterial infection was caused by Pseudomonas aeruginosa, which was identified in 36.84% of the co-infection cases (7/19). This was followed by Acinetobacter baumannii in 31.57% (6/19), Klebsiella pneumoniae in 26.31% (5/19), and Stenotrophomonas maltophilia in 5.28% (1/19). Acinetobacter baumannii and Klebsiella pneumoniae showed high drug resistance, ranging from 60% to 100% against various groups of drugs tested. None of the patient samples with co-infection showed rifampicin resistance. Among all the samples with co-infection, the majority (42.10%, or 8/19) had a high load of Mycobacterium tuberculosis complex detected by CBNAAT Ultra (Cepheid, Sunnyvale, California). Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae are unusual pathogens causing infection in community patients and are known to cause illness in hospitalized patients. These organisms' resistance was also similar to the resistance shown by hospital-acquired infections. This indicates that bacterial co-infection in pulmonary TB patients will be similar to the pattern of hospital-acquired infections. The high prevalence of bacterial co-infections (10.91%) in patients with pulmonary TB poses a significant challenge as these bacterial pathogens are not susceptible to anti-tubercular drugs. Therefore, comprehensive screening for other bacterial infections in all pulmonary TB patients is crucial for effective treatment and outcomes.

Background: Post-tuberculosis lung disease (PTLD) is defined as chronic lung abnormalities resulting from a previous history of pulmonary tuberculosis. The sequelae of PTLD can manifest as impaired lung function and structural damage, including the formation of cavities. This case report aims to present a co-infection of Klebsiella pneumoniae and Candida glabrata in a post-tuberculosis patient that caused a lung abscess. Case Presentation: A 53-year-old male presented with complaints of fever lasting for the past 10 days. Night sweats accompanied the fever. The patient also reported a productive cough with yellow, foul-smelling sputum without the presence of blood. Additional symptoms included left-sided chest pain and weight loss. The patient had a history of pulmonary tuberculosis 20 years ago, which was successfully treated with a 6-month course of medication. A chest X-ray examination revealed a thick-walled cavity in the lower field of the left lung. Sputum culture results isolated two dominant microorganisms, Klebsiella pneumoniae and Candida glabrata. The patient underwent a contrast-enhanced computed tomography (CT) scan of the chest, which revealed a lung abscess in the left lower lobe measuring approximately 10 x 4.4 x 6.6 cm. The patient received medical therapy and pulmonary rehabilitation, which showed significant improvement. Conclusion: A case has been reported of a 53-year-old male suffering from a left lung abscess due to co-infection with bacteria and fungi in a post-tuberculosis patient. The patient received medical therapy and pulmonary rehabilitation, which demonstrated clinical improvement after hospitalization, and monthly evaluations are planned at the outpatient clinic.

Tuberculosis (TB) is known to be one of the oldest forms of human diseases which still remain the leading cause of death worldwide. It is characterized as a pulmonary disease which occurs due to accumulation of Mycobacterium tuberculosis (MTB) onto the lungs alveolar surfaces. M. tuberculosis is an implicated pathogenic bacteria associated with T.B. It is the chronic infectious disease caused by the tubercle bacillus (M. tuberculosis). This study was aimed to determine co-infection of other pathogenic bacteria within MTB patients attending Federal Medical Centre (FMC), Katsina. The study design was cross-sectional, conducted to isolate some pathogenic bacteria that co-infected TB patients who are Acid fast bacilli (AFB) positive and AFB negative. The samples obtained were cultured on Blood, Chocolate and MacConkey agar and incubated at 37oC for 24 hours. Pure isolates were confirmed using Grams Staining and biochemical reaction. Data obtained were presented as simple percentage and using statistical analysis which revealed that the incidence was common among the age categories 51-60 with 28%, followed by those ≥60 years with 20%. The lowest prevalence was recorded the at age category 11-20 with 10%. Based on gender, males presented with the higher incidence (35/50) i.e. 70% than female (15/50) i.e. 30%. Klebsiella pneumoniae, Staphyllococcus aureus and Pseudomonas aeruginosa were the most prevalent organisms isolated with 21.9%, 19.66% and 19.10% respectively. E. coli with 05.62% being had the least isolates. The research demonstrated the existence of both Gram positive and Gram negative bacterial pathogens that co-infect with TB patients, especially among the elderly males. Further research should be tailored towards investigating other pathogens that co-infect with MTB patients, such as fungi and viruses, in diversified hospitals in Katsina state and beyond.   Keywords: AFB, Pathogenic bacteria, Tuberculosis and Mycobacterium and Federal Medical Centre, Katsina.

BACKGROUND Patients presenting with symptoms suggestive of pulmonary tuberculosis (TB) often harbor other bacterial pathogens that contribute to respiratory illness. However, the frequency, clinical relevance, and antibiotic resistance profiles of these bacterial co-infections are not well characterized, particularly in settings with high TB burden. METHODOLOGY The sample size consisted of 220 participants from which sputum were obtained. The samples were analysed for TB using Ziehl-Nelseen staining, while the presence of co-infection and the associated organism was determined using Gram staining, culture, and biochemical test. The antimicrobial susceptibility pattern of the isolates was performed using the disc diffusion method. RESULTS The study identifies differences in the prevalence and diversity of bacterial co-infections between TB-positive and TB-negative patients. Resistance patterns also varied across groups, with certain pathogens showing higher levels of multidrug resistance in one group compared to the otherThe overall prevalence of TB was 23.2 %. TB prevalence was significantly (p ≤ 0.05) higher among those 60-69 years (42.9 %) and males (30.4 %). The prevalence of bacterial co-infection with TB was 78.4 % and Staphylococcus species was the most common agent (37.3 %). Non-mycobacterial organisms were detected from 64.5 % of those without tuberculosis and Streptococcus was the most common agent (32.5 %). Meropenem and ampicillin were the most and least effective antibiotics respectively with the bacterial isolates showing variable susceptibility to the various antibiotics. CONCLUSION Bacterial co-infections are common among patients suspected of having pulmonary TB, and their resistance profiles differ between TB-confirmed and non-TB patients. These findings highlight the need for routine bacterial screening and tailored antibiotic therapy in managing respiratory infections in TB-endemic settings.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, which is widespread and harmful worldwide. It can attack multiple organs throughout the body, with pulmonary tuberculosis being the most common. The Global Tuberculosis Report 2024 shows an increase in the incidence of TB from the previous year, and its transmission is closely linked to the response of the host immune system. In clinical settings, co-infections with other pathogens are becoming more common. 10.8 million new TB cases were diagnosed globally in 2023, of which 662,000 were co-infected with HIV, and the risk of death in patients with TB-HIV co-infections with HIV is three times higher than in patients with TB alone. Such co-infections significantly increase the complexity of the disease and the difficulty of diagnosis and treatment, and may further exacerbate the global burden of TB through a combination of immunosuppression, primary resistance due to the spread of drug resistance, and the extension of the chain of transmission, making it an important challenge for global public health to address. In this review, we will discuss some common pathogens that are co-infected with TB, with the aim of sorting out the related research progress and providing reference for the subsequent TB control.

Tuberculosis is a global disease problem that is still difficult to overcome. WHO reports that TB cases are increasing from year to year. This is directly proportional to the mortality rate due to TB, which has increased significantly, reaching 1.6 million by 2022. High mortality rates can result from immunosuppression and co-infection by other microorganisms such as bacteria, fungi, and viruses. This can prolong symptoms and worsen the patient’s condition. This article presents a bibliometric study of research articles on tuberculosis co-infection with microorganisms indexed in the Scopus journal database from 1966 to 2024. An accumulating total of 422 documents were disseminated globally, averaging 14 documents annually. The US produced the most documents (94), followed by India (73), the UK and South Africa (40), and China (33). Since 2002, global publishing numbers have continually increased. Co-infections, microbiology of co-infection, clinical articles, and case reports are popular trends these days. This study provides a comprehensive overview of global research on tuberculosis co-infections with microorganisms, spanning from 1966 to 2024.

Secondary pulmonary infections are crucial and pivotal contributing factors to clinical deterioration in patients with pulmonary tuberculosis. Research remains limited regarding the specific population and regional epidemiology of these secondary infections, despite its clinical importance. This study provides an in-depth analysis of the primary bacterial pathogens and their antimicrobial resistance rates among hospitalized pulmonary tuberculosis patients with concurrent pulmonary infections in Yangzhou, China, from 2021 to 2024. Suitable sputum samples and leftover bronchoalveolar lavage fluid samples were collected for bacterial culture identification and drug sensitivity testing. The annual and regional distributions of strains and the evolution of resistance rates were analyzed using the chi-square test and the Cochran-Armitage trend test. A total of 514 strains of pathogenic bacteria were cultured from 410 samples, with 499 strains (97.08 %) being Gram-negative bacteria. Klebsiella pneumoniae was the most common Gram-negative bacterium (40.27 %), followed by Pseudomonas aeruginosa (15.18 %), while Staphylococcus aureus was the primary Gram-positive bacterium (1.75 %). The drug sensitivity tests results over different years showed that K. pneumoniae exhibited significant resistance rates against doxycycline, ceftazidime, cefepime, cefuroxime, cefazolin, cefotaxime, levofloxacin, ticarcillin/clavulanate, amikacin, and norfloxacin (P < 0.05). The resistance rates of P. aeruginosa to cefazolin and ciprofloxacin were also statistically significant (P < 0.05). The drug sensitivity test results across different regions showed that the resistance rate of K. pneumoniae to minocycline in urban patients was statistically significant (P = 0.012), while the resistance rates of P. aeruginosa to tobramycin and ciprofloxacin in rural patients were statistically significant (P < 0.05). Annual statistics of extended-spectrum beta-lactamase ESBL-producing K. pneumoniae resistant strains showed significant annual increases (P < 0.05). Moreover, data on resistant strains in urban and rural areas indicated that the detection rate of ESBL-producing Escherichia coli in rural areas was higher than that in urban areas (P = 0.052), and the detection rate of ESBL-producing K. pneumoniae resistant strains in rural areas was significantly higher than in urban areas (P = 0.005). The rise of new carbapenem-resistant K. pneumoniae strains in 2023 should be monitored. This study provides strong data support to formulate antibiotic treatment plans for patients with tuberculosis and respiratory infections, reduce the risk of resistant strain transmission, and optimize clinical treatment strategies.

Tuberculosis (TB) along with pulmonary co-infections in patients became a grave concern to public health complicating the disease diagnosis, treatment, and prognosis. It became a challenge to healthcare professionals urging to develop new diagnostic tools and treatment regimens. This paper reviews the complex interplay and management strategies for Tuberculosis patients with co-infections. It encompasses antimicrobial therapy tailored to particular pathogens, including their susceptibility profiles to antibiotics, and understanding the potential implications of drug interactions with anti- Tuberculosis medications. In cases of co-infection between Tuberculosis and Human Immuno-Deficiency Virus (HIV), a particular focus is placed on the significance of synergistic methods and treatment duration. Moreover, immunomodulatory drugs, immunotherapies, cellular treatments, adjunct therapies, and immunomodulatory agents that are customised to the patient's immunological status and co-infecting pathogens emerge as a crucial component. Mitigating the transmission of pulmonary co-infections requires the implementation of infection control measures in both healthcare settings and communities. A strong barrier against the spread of tuberculosis and related illnesses is formed by administrative, engineering, and personal protective measures combined with screening, education, isolation, and contact tracking. Prospective approaches underscore the necessity for enhanced diagnostic instruments, promoting cutting-edge technologies including molecular diagnostics, immunological tests, radiological imaging, biosensors, and point-of-care diagnostics. Comprehensive management is emphasised through multidisciplinary care comprising pulmonologists, infectious disease experts, microbiologists, and immunologists. Priorities for research include combination medications, new therapeutic approaches, personalised medicine, and developing diagnostic techniques to improve knowledge of and treatments for pulmonary co-infections.

A 71-year-old male a chronic smoker, who also had diabetes mellitus and hypertension presented with complaints of fever, cough with foul-smelling sputum and dyspnoea for 25 days. Coarse crepitations were evident in the interscapular area, infrascapular, axillary, infra-axillary and mammary areas on the left side. Contrast-enhanced computed tomography of the chest showed necrotic mediastinal lymph nodes and areas of consolidation in the left upper lobe. Bronchoalveolar lavage fluid polymerase chain reaction identified Staphylococcus, New Delhi metallo-β-lactamase (NDM) producing Klebsiella; GeneXpert detected Mycobacterium tuberculosis complex. Pleural fluid analysis was suggestive of exudative effusion with elevated adenosine deaminase. The patient was managed with anti-tuberculosis treatment, ceftazidime-avibactam, aztreonam and linezolid.

Background Bacterial co-infections significantly affect the treatment outcomes of tuberculosis (TB) patients, particularly in resource-limited settings. Misdiagnosis of TB co-infections accelerate disease progression and contribute to the development of drug resistance, leading to higher mortality and morbidity rates, especially in underserved areas. This study aimed to investigate bacterial co-infections in patients with pulmonary tuberculosis in a rural Vhembe region of Limpopo, South Africa. Materials and methods A total of 100 sputum together with 100 blood samples were collected from TB patients who were undergoing TB treatment. DNA isolates were used as templates for PCR using the Anyplex™MTB/NTMe Assay kit, and subsequently, the Allplex™ MTB/MDR/XDRe Assay kit was used for the multiple detections of Mycobacterium tuberculosis (MTB) and resistance to first line and second line anti-TB drugs. Co-infections were determined using the Allplex™ Bacteria(I) & (II) Assay kit. HIV status of patients was determined using blood testing kits. Results Majority of study participants were male (55 %) and aged between 36 and 55 (54 %), while female were 46 % of the population. Bacterial species detected included non-tuberculous mycobacteria (NTM) in 67 % of participants, Aeromonas spp. (19 %), Vibrio spp. (2 %), and E. coli (2 %). Multidrug-resistant Mycobacterium tuberculosis (MTB) strains were identified in 2 % of the cohort. There was a significant association between employment status and age (p = 0.00), as well as between HIV status and age (p = 0.03). While no significant associations were found between HIV status and the presence of NTM or other bacterial co-infections (p = 0.19 and 0.21, respectively), the majority of Aeromonas spp. and NTM cases were observed among HIV-positive participants. Notably, 36 of the NTM cases occurred in individuals living with HIV. Conclusion The study findings suggest that age, socioeconomic status, and gender play a role in the development of TB, HIV, and other bacterial infections, which could further complicate treatment outcomes in patients. These factors likely contribute to increased vulnerability to co-infections, emphasizing the complex interplay between TB and HIV in these populations. Additionally, the study emphasises the importance of considering these socio-demographic factors in public health interventions to reduce the burden of TB-HIV co-infection and associated bacterial infections.

IntroductionBacterial infections may appear as sequelae of remote tuberculous infections, especially thoracic infections. The simultaneous appearance of tuberculosis and bacterial infection is not common, and, to our knowledge, the association of infection by Streptococcus anginosus and Mycobacterium tuberculosis has not been reported previously in the literature.Case presentationWe report three cases of dual infection with Streptococcus anginosus and Mycobacterium tuberculosis that were first diagnosed as pyogenic abscesses because of an isolation of Streptococcus anginosus. Despite a course of antibiotics and drainage, the outcome of this initial treatment was unfavourable. A re-evaluation yielded a diagnosis of mixed infection with Streptococcus anginosus and Mycobacterium tuberculosis.ConclusionIn a geographical area with a high prevalence of tuberculous disease, the rare possibility of dual infection with Streptococcus anginosus and Mycobacterium tuberculosis should be considered.

Background Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent airflow limitation. Infection with either Mycobacterium tuberculosis or Nocardia in COPD patients has been reported. However, co-infection with Mycobacterium tuberculosis and Nocardia is rare. Herein, we described such a patient with COPD in a primary hospital, and the diagnosis process. Case presentation A 79-year-old female farmer with COPD was consecutively admitted to two hospitals with chief complaints of worsening cough, sputum and gasping since January10, 2022. Microbiological examination was not performed at the first hospital due to unknown reasons, and empirical antibiotic treatment was not effective. The patient was subsequently referred to our hospital. After screening the source of infection and the pathogen, she was diagnosed with tuberculosis. However, the patient did not benefit from antituberculosis treatment, with no remission of respiratory tract symptoms. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for microbiological examination. The results indicated Mycobacterium tuberculosis and Nocardia.spp . After four days of bacterial culture, Nocardia.spp grew on medium, and Nocardia.farcinica was identified by the MALDI-TOF MS system and 16 s RNA. The patient was prescribed trimethoprim sulfamethoxazole (TMP/SMX) in combination with anti-tuberculosis drugs to treat the co-infection. She showed gradual improvement and was discharged from the hospital on February 19, 2022. However, the follow-up results were unclear. Conclusions Co-infection with Nocardia and Mycobacterium tuberculosis should be considered in COPD patients. Repeated microbiological and microscopy examinations are essential in primary hospitals.

Patient: Male, 65-year-old Final Diagnosis: Tuberculosis Symptoms: Cough accompanied by greenish expectoration • chest pain • asthenia • weight loss Medication: — Clinical Procedure: Thoracic drainage tube and bronchoscopy Specialty: Critical Care Medicine Objective: Rare co-existance of disease or pathology Background: Spontaneous pneumothorax can be secondary to a wide variety of lung diseases. Spontaneous pneumothorax secondary to pulmonary tuberculosis occurs in rare cases of residual fibrosis with retractions and bullae. Case Report: We present the case of a 65-year-old male patient from a rural area in the province of Los Ríos in Babahoyo, Ecuador, with no history of contact with tuberculosis. The patient arrived at the Emergency Department of the Regional Hospital of the Instituto Ecuatoriano de Seguridad Social (IESS), Babahoyo, due to acute respiratory failure, preceded by 10 days of evolution due to cough accompanied by greenish expectoration, chest pain, asthenia, and weight loss. On chest radiography, a left pneumothorax and interstitial pulmonary infiltrate were reported. A chest tube was placed, and the patient was intubated and was placed on invasive mechanical ventilation due to severe respiratory failure. Use of the GeneXpert MTB/RIF System detected Mycobacterium tuberculosis without resistance to rifampicin. Ziehl-Neelsen (ZN) staining for the identification of bacillus acid-resistant alcohol was positive in alveolar bronchial lavage. MALDI-TOF mass spectrometry and phenotypic analysis showed the presence of Pseudomonas aeruginosa and Klebsiella pneumonia with carbapenemases resistance mechanism, and the KPC type enzyme was identified. The culture for Mycobacterium tuberculosis was positive from the fourth week. Conclusions: Secondary pneumothorax due to rupture of the polymicrobial cavity and especially of tuberculous origin is a very special form of acute respiratory failure in patients with previous structural pulmonary lesions in the Emergency Department.

Objective To investigate the bacterial distribution and drug resistance profile of urinary tract infections (UTIs) in tuberculosis patients, and to provide evidence-based support for the rational clinical use of antimicrobial agents in this specific patient population. Methods A retrospective analysis was performed on bacterial identification and antimicrobial susceptibility test results of tuberculosis patients complicated with UTIs in our hospital from January 2020 to December 2024. Data were processed via WHONET 5.6 and SPSS 21.0. Results A total of 1,151 strains were isolated, including 878 Gram-negative strains (76.3%, mainly Escherichia coli 34.9% and Klebsiella pneumoniae 22.2%) and 273 Gram-positive strains (23.7%, predominantly Enterococcus faecium 15.6%). Escherichia coli showed low resistance to cefoperazone/sulbactam, amikacin, tigecycline and carbapenems (resistance rate < 5%). Klebsiella pneumoniae showed low resistance only to tigecycline (resistance rate 0%), while Enterococcus faecium showed low resistance to quinupristin/dalfopristin, linezolid, high concentrations of Streptomycin, high concentrations of Gentamicin, tigecycline and vancomycin (resistance rate < 5%). Additionally, Klebsiella pneumoniae resistance rates to multiple antimicrobials were significantly higher in male patients than in females (all p < 0.05). Severe tuberculosis patients had notably higher resistance rates of Escherichia coli to amoxicillin/clavulanate, ertapenem, and Klebsiella pneumoniae to multiple antimicrobials (all p < 0.05). Conclusion Continuous monitoring of bacterial distribution and drug resistance in tuberculosis patients with UTIs is essential to improve diagnosis and treatment accuracy and guide rational clinical medication use.

Background/objective Data on acute respiratory failure (ARF) in pulmonary tuberculosis (PTB) patients is limited. This study aims to investigate in-hospital mortality, its clinical risk factors and the accuracy of the existing scoring system in predicting in-hospital mortality. Methods An observational prospective cohort study involving PTB patients with ARF in tertiary hospital, between January 2017 and December 2018, was conducted. The in-hospital mortality was predicted using the National Early Warning Score 2 (NEWS2), quick Sequential Organ Failure Assessment (qSOFA) and CRB-65. Regression models were run to analyze the clinical risk factors for in-hospital Mortality. Sensitivity and specificity of scoring systems were calculated using a Wilson score interval. Results A total of 111 subjects were included. Most of subjects were hypoxemic type respiratory failure (68.5%), advanced lesions (62.2%), new cases (70.3%) and pneumonia co-infection (72.1%) patients. Invasive mechanical ventilation was utilized for 29.73% of cases. There were 53 (47.75%) in-hospital mortality cases and its risk factors were intensive phase treatment (3.34 OR; CI95% 1.27–8.78), P/F ratio < 100 (OR 4.30; CI 95% 1.75–10.59) and renal insufficiency (4.09 OR; CI95% 1.46–11.49). The sensitivity and specificity of NEWS2 ≥ 6, qSOFA ≥ 2 and CRB-65 ≥ 2 were 62.26% and 67.24%; 60.38% and 72.41%; 41.51% and 84.48% respectively. Conclusions Most of PTB with ARF were new cases, advanced lesion and hypoxemic type respiratory failure. Intensive phase treatment, severe hypoxemia and renal insufficiency are independent predictors of in-hospital mortality in PTB patients with ARF. NEWS2, qSOFA and CRB-65 scores were poor to predict the in-hospital mortality.

Background Mixed tuberculosis (TB) and bacterial respiratory infections are usually seen in areas where there is an HIV epidemic. However, there have been no previous reports regarding TB patients with concomitant bacterial respiratory infections in a non-HIV prevalent region. This study was to evaluate the clinical characteristics and outcomes of patients with dual TB and bacterial respiratory infections in Hualien, Taiwan. Methods A retrospective cohort study was conducted in a community teaching hospital in Hualien from 2000 to 2007. Those who fulfilled the criteria for active pulmonary tuberculosis (PTB) were included and divided into subjects with concomitant bacterial infections and controls. Their basic data, clinical presentations and in-hospital outcomes were reviewed and analyzed. Results During 2000 - 2007, a total of 182 patients were diagnosed as having PTB. Of them, 54 (29.7%) had dual infections. Comorbidities were common in these patients. Older age and lower socioeconomic status were present in subjects than in controls. In terms of disease characteristics, symptoms of cough and sputum production, laboratory findings of leukocytosis with left shift, thrombocytopenia, renal insufficiency and lower serum albumin level, as well as radiographic patterns of multi-lobar infiltrates and alveolar consolidations prevailed amongst subjects (P < 0.05). Delayed diagnosis in PTB and increased rates of in-hospital morbidity and mortality associated with polymicrobial infections were noted in subjects with dual infections. Conclusions In a non-HIV prevalent area, patients of older age, lacking access to good health care, and suffering from malnutrition were predisposed to dual infections and had poor prognosis and outcomes. Keywords Pulmonary tuberculosis; Dual nontuberculous bacterial respiratory infections

… left lower lobe in addition to pulmonary tuberculosis and metastatic carcinoma. On January … The following day acute respiratory distress with a high fever developed and K . pneumoniae, …

Klebsiella pneumoniae and Mycobacterium tuberculosis coinfection is one of the most lethal combinations that has been becoming frequent yet, not diagnosed and reported properly. Due to the simultaneous occurrence of both infections, diagnosis is delayed leading to inadequate treatments and mortality. With the rise of MDR Klebsiella and Mycobacterium, a prophylactic and an immunotherapeutic vaccine has to be entailed for preemptive and adroit therapeutic approach. In this study, we aim to implement reverse vaccinology approach that encompasses a comprehensive evaluation of vital aspects of the pathogens to explore immunogenic epitopes against Omp A of Klebsiella and Rv1698, Rv1973 of Mtb that may help in vaccine development. The designed multi-epitopic vaccine was assessed for antigenicity, allergenicity and various physiochemical parameters. Molecular docking and simulations were executed to assess the immunogenicity and complex stability of the vaccine. The final multi-epitopic vaccine is validated to be highly immunogenic and can serve as a valuable proactive remedy for subject pathogens.

Here in we report a diagnostically challenging case of adult hemophagocytic lymphohistiocytosis (HLH) triggered by disseminated tuberculosis and Klebsiella pneumoniae co-infection in an immunocompetent Individual. She was a young female presented with complaints of fever, abdominal pain and jaundice. Her evaluation showed cytopenias, hyperbilirubinemia, transaminitis, and hepatosplenomegaly. She progressed to have multi-organ involvement in the form of myocarditis, pleural effusion. Provisional diagnosis of fever with unknown origin and sepsis with multiple-organ dysfunction was made and evaluated for the same. Rapid clinical deterioration with evaluation for sepsis being normal prompted for considering HLH in the differential diagnoses, bone marrow and other criteria have been met resulting in confirmation of the same. Without prior past or family history of HLH, secondary HLH was suspected and substantial evaluation for possible triggers was made, and concomitantly immune suppression was started with corticosteroids. Disseminated tuberculosis was diagnosed and concomitantly Klebsiella pneumoniae was isolated from the bronchioalveolar lavage cultures. As there was no significant immune response culmination, intravenous immunoglobulins were added along with the treatment for possible triggers-tuberculosis and Klebsiella simultaneously. Patient showed significant improvement with this approach. In conclusion management of HLH is different from conventional sepsis and the treatment for each cause of HLH also varies. Furthermore, this case report stresses on the importance for initiating treatment rapidly and tailored approach of management therapy for each case.

Background: Tuberculosis (TB) causes over a million deaths annually and is still one of the most important public health problems worldwide. According to the World Health Organization estimates, the highest rates of TB in the European Region are in Tajikistan, Kazakhstan, Moldova, Kyrgyzstan, Romania, and Uzbekistan. The purpose of this study was to investigate the spectrum of nonspecific microorganisms isolated in patients with multidrug-resistant TB in Central Kazakhstan and to assess their susceptibility to antimicrobial drugs. Methods: The patients were divided into 2 groups: group 1 with multidrug-resistant forms of pulmonary TB (n = 107 patients); group 2 with sensitive forms of pulmonary TB (n = 122 patients). Gender, age, and social status of the patients were studied. Microorganisms were identified using the MALDI-TOF method. The statistical significance of different values for binary and nominal parameters was determined using the chi-square test. Changes in binary variables were analyzed using the McNeimer test. Results: During the study, an expectedly high proportion of tetracycline-resistant pneumococcal strains (66.7% and 60%, respectively) was isolated, which was a consequence of a long-term and practically uncontrolled use of these drugs in Kazakhstan. Fluoroquinolones showed low activity. The results showed that beta-lactam antibacterial drugs maintained their high activity against the causative agents of pneumococcal infection. Conclusion: It was concluded that secondary microorganisms isolated in patients with multidrug-resistant TB were represented by the strains that were resistant to modern antibacterial drugs. Therefore, for appropriate antibiotic prescription, it is necessary to study materials from the respiratory system in all patients admitted for TB treatment to study the spectrum of nonspecific microorganisms and assess their susceptibility to antimicrobial drugs.

… also showed chronic chest infection and the use of antibiotics are risk factors for colonization with Klebsiella pneumoniae. Therefore the use of multiple antimicrobial agents in the …

Secondary bacterial infection has become one of the most important complications in patients suffering with pulmonary tuberculosis (PTB). The suppression of immunity, which can occur due to T-lymphocyte deficiency during active PTB disease, could be the main reason for the bacterial superadded infections. This aimed to evaluate tuberculosis (TB) status and secondary bacterial infections among them. A total of 400 sputum samples were collected and examined using Ziehl-Neelsen staining method as per revised national tuberculosis control program guidelines and GeneXpert following the WHO guidelines. Those sputum samples were also processed for routine bacterial culture and bacteria were identified by conventional techniques. Antimicrobial sensitivity testing was performed on Mueller-Hinton agar plates with commercially available antibiotic discs using Kirby-Bauer disc diffusion techniques and interpreted as per the guidelines of Clinical and Laboratory Standards Institute (CLSI). A total of 44 (11.0%) samples out of 400 yielded tuberculosis by GeneXpert assay and maximum positivity was noted among the age group 46-60 years (20.4%). The present study showed GeneXpert positivity for the MTB detected rate remained to be 11.0 % (44/400) detected as against smear positivity in only 7.5% (30/400) and this difference was found to be statistically significant (p<0.001). Overall, 220 (55.0%) secondary bacterial pathogens were isolated. Gram negative bacterial infection was most common. Of them, Klebsiella pneumoniae (33.63%; 74/220) was the commonest organism followed by Acinetobacter spp. (30%;66/220) and Pseudomonas aeruginosa (18%; 40/220). Streptococcus pneumoniae (6.36%; 14/220) was the commonest among the gram-positive bacteria. Majority (54.0%) of Klebsiella spp. showed resistance to Ciprofloxacin, while 29.7% Imipenem, 32.4% to Gentamicin, 35.13% to Piperacillin/Tazobactum, 37.8% to Amikacin. However, (70.0%) of Acinetobacter spp. showed resistance to Ciprofloxacin, while 75.7% were resistant to Ceftazimine, 54.5% Imipenem, 48.4% to Gentamicin, 31.0% to Amikacin. Interestingly, 44 of these 400 (11.0%) were found to positive be MTB by GeneXpert test and 220/400 (55.0%) bacterial infection and coinfection 22/44 (50.0%) among clinically suspected PTB cases. Tuberculosis remains a global threat despite effort to eradicate the disease and PTB co-infection with secondary bacterial infection may complicate the infection and treatment.

… Cultures of the pus were positive for Klebsiella pneumoniae and Candida albicans and polymerase chain reaction for Mycobacterium tuberculosis was concurrently positive; the patient …

Abstract Early diagnosis of tuberculosis (TB), followed by effective treatment, is the cornerstone of global TB control efforts. An estimated 3 million cases of TB remain undetected each year. Early detection and effective management of TB can prevent severe disease and reduce mortality and transmission. Intrinsic and acquired drug resistance of Mycobacterium tuberculosis (MTB) severely restricted the anti-TB therapeutic options, and public health policies are required to preserve the new medications to treat TB. In addition, TB and HIV frequently accelerate the progression of each other, and one disease can enhance the other effect. Overall, TB-HIV co-infections show an adverse bidirectional interaction. For HIV-infected patients, the risk of developing TB disease is approximately 22 times higher than for persons with a protective immune response. Analysis of the current TB challenges is critical to meet the goals of the end TB strategy and can go a long way in eradicating the disease. It provides opportunities for global TB control and demonstrates the efforts required to accelerate eliminating TB. This review will discuss the main challenges of the TB era, including resistance, co-infection, diagnosis, and treatment.

Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca is a singularly uncommon cause of CAP. The chronic form of the disease caused by K. oxytoca has been documented only once before. A 50-year-old immunocompetent male smoker presented with haemoptysis for 12 months. Imaging demonstrated a cavitary lesion in the right upper lobe with emphysematous changes. Sputum stains and cultures for Mycobacterium tuberculosis were negative. However, three sputum samples for aerobic culture as well as bronchial aspirate cultured pure growth of K. oxytoca. A diagnosis of chronic pneumonia due to K. oxytoca was established and with appropriate therapy, the patient was largely asymptomatic. The remarkable clinical and radiological similarity to pulmonary tuberculosis can result in patients with chronic Klebsiella pneumonia erroneously receiving anti-tuberculous therapy.

… However, prior antibiotic therapy did not affect the likelihood of isolation of Klebsiella pneumoniae, S. aureus, Haemophilus influenzae or Escherichia coli from the blood. …

… Klebsiella pneumoniae is a well-known cause … pulmonary pyogenic complications such as abscesses and empyemas is substantial, and chronic pneumonia that resembles tuberculosis …

There are limited data on risk of severe disease or outcomes in patients with influenza and pulmonary tuberculosis (PTB) co‐infection compared to those with single infection.

… The demographic features, laboratory data, treatment, and prognosis of these two groups were compared and analyzed. We used chi-squared test, Fisher’s exact test, Mann–Whitney U …

Objective To systematically review and critically evaluate prediction models developed to predict tuberculosis (TB) treatment outcomes among adults with pulmonary TB. Design Systematic review. Data sources PubMed, Embase, Web of Science and Google Scholar were searched for studies published from 1 January 1995 to 9 January 2020. Study selection and data extraction Studies that developed a model to predict pulmonary TB treatment outcomes were included. Study screening, data extraction and quality assessment were conducted independently by two reviewers. Study quality was evaluated using the Prediction model Risk Of Bias Assessment Tool. Data were synthesised with narrative review and in tables and figures. Results 14 739 articles were identified, 536 underwent full-text review and 33 studies presenting 37 prediction models were included. Model outcomes included death (n=16, 43%), treatment failure (n=6, 16%), default (n=6, 16%) or a composite outcome (n=9, 25%). Most models (n=30, 81%) measured discrimination (median c-statistic=0.75; IQR: 0.68–0.84), and 17 (46%) reported calibration, often the Hosmer-Lemeshow test (n=13). Nineteen (51%) models were internally validated, and six (16%) were externally validated. Eighteen (54%) studies mentioned missing data, and of those, half (n=9) used complete case analysis. The most common predictors included age, sex, extrapulmonary TB, body mass index, chest X-ray results, previous TB and HIV. Risk of bias varied across studies, but all studies had high risk of bias in their analysis. Conclusions TB outcome prediction models are heterogeneous with disparate outcome definitions, predictors and methodology. We do not recommend applying any in clinical settings without external validation, and encourage future researchers adhere to guidelines for developing and reporting of prediction models. Trial registration The study was registered on the international prospective register of systematic reviews PROSPERO (CRD42020155782)