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ID consults improve management of cryptococcosis in patients without HIV
Recent data published in Clinical Infectious Diseases indicated that patients with cryptococcosis who received an infectious disease consult had lower 3-month mortality rates and were more likely to be managed in accordance with evidence-based Infectious Diseases Society of America guidelines.
“Several studies have shown a predisposition towards lower mortality in cryptococcal patients with HIV, and worse outcomes in cryptococcal non-solid organ transplant (SOT) patients who are HIV-negative,” William G. Powderly, MD, president of the IDSA, and colleagues wrote. “Treatment consistent with [IDSA] guidelines has been associated with improved outcomes in cryptococcal patients, both in selection of induction treatment and management of opening pressure.”
Powderly and colleagues compared outcomes among patients with cryptococcal infection who had an ID consultation with those who did not have an ID consultation. They examined whether disease management recommended by ID physicians was more likely to follow evidence-based guidelines than recommendations from other physicians. In this retrospective cohort study, the researchers assessed roughly 150 consecutive cases of cryptococcosis in patients without HIV.
The researchers found the patients with an ID consult had higher fungal burden, but lower 90-day mortality compared with patients without consult (27% vs. 45%; P < .001), with a hazard ratio of 4.1 (95% CI, 2.2-7.6). The researchers observed that the group with ID consultations were more likely to receive indicated lumbar puncture (86% vs. 32%; P < .001), and more likely receive treatment using amphotericin B (AmB; 87% vs. 24%; P < .001) and flucytosine (5-FC; 57% vs. 16%; P < .001) when needed. They saw longer duration of therapy with AmB and 5-FC in the ID consult group compared with those without consultation (14 vs. 11 days; P = .05; and 7.5 vs. 1 days; P < .001, respectively).
“The lower mortality in the ID consult group may be due at least in part to increased adherence to management based on evidence-based recommendations, as patients seen by an ID physician were more likely to receive an appropriate [lumbar puncture] and to be treated with AmB and 5-FC when indicated,” Powderly and colleagues wrote. “Our results suggest that an ID consult is appropriate in all patients with cryptococcosis in order to improve outcomes and reduce mortality. – by Savannah Demko
Disclosure: Powderly has received research funding from MiraVista and Scynexis, and consults for Gilead Sciences and Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.
*Editor’s note: This article has been updated with the correct financial disclosures of William G. Powderly, MD. The editors regret the error.