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. 2017 Mar 1;64(5):558-564.
doi: 10.1093/cid/ciw786. Epub 2016 Dec 7.

Impact of Infectious Diseases Consultation on Mortality of Cryptococcal infection in Patients without HIV

Andrej Spec  1 , Margaret A Olsen  1 , Krunal Raval  1   2 , William G Powderly  1
Affiliations

Impact of Infectious Diseases Consultation on Mortality of Cryptococcal infection in Patients without HIV

Andrej Spec et al. Clin Infect Dis. .

Abstract

Background: An infectious disease (ID) consultation is often obtained to treat patients with cryptococcosis due to the complex nature of the disease, but has never been demonstrated to impact outcomes.

Methods: We assembled a retrospective cohort of 147 consecutive cases of cryptococcosis in patients without HIV. Patients who were diagnosed less than 24 hours prior to death were excluded. Survival analysis was performed with Cox regression with survival censored past 90 days.

Results: The patients with an ID consult had a higher fungal burden but a lower 90-day mortality compared to patients without ID involvement (27% vs 45%, p<0.001), with an adjusted hazard ratio of not receiving an ID consult of 4.1 (95% CI: 2.2, 7.6). The ID consult group was more likely to receive an indicated lumbar puncture (86% vs 32%, p<0.001), and more likely to be treated with amphotericin B (AmB) (87% vs 24%, p<0.001) and flucytosine (5-FC) (57% vs 16%, p<0.001) when indicated. The duration of therapy with AmB (14 vs 11 days, p=0.05) and 5-FC (7.5 vs 1 days, p<0.001) was longer in the ID consult group.

Conclusions: Patients that received an ID consult were significantly less likely to die in the 90 days following diagnosis. Patients seen by ID physicians were more likely to be managed according to evidence based practice established by randomized controlled trials and published in IDSA guidelines. These data suggest that an ID consult should be an integral part of clinical care of patients with cryptococcosis.

Keywords: Adult; Cryptococcus; Infectious Disease Consult; Mortality; Prognosis; Therapy.

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Figures

Figure 1.
Figure 1.
Survival curve of 147 Human Immunodeficiency Virus-uninfected patients with cryptococcosis by receipt of infectious disease (ID) consultation adjusted for a positive cryptococcal antigen test, age >55 years, end-stage liver disease, and receipt of chemotherapy. Patients without an ID consultation had a higher mortality than those who did (P < .001). This was most pronounced in the first 15 days. Mortality was censored after 90 days as it was less likely to be related to cryptococcosis. Solid line indicates ID consultation; dashed line indicates no ID consultation.
See this image and copyright information in PMC

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