DisseminatedCryptococcus neoformansvar.grubiiinfections in intensive care units

Abstract

SUMMARYA retrospective study of clinical characteristics, outcome and prognostic factors of patients with cryptococcosis was undertaken in intensive care units (ICUs) of a medical centre for the period 2000–2005. Twenty-six patients withCryptococcus neoformansvar.grubiiinfection were identified (16 males, median age 58 years). The most frequent underlying diseases were liver cirrhosis (38·5%), diabetes mellitus (26·9%) and HIV infection (19·2%). The most frequently identified sites of infection were blood (61·5%), cerebrospinal fluid (38·5%) and airways (34·6%). The mean Acute Physiologic and Chronic Health Evaluation II score at ICU admission was 22·46. The ICU mortality rate in these patients was 73·1% (19/26) and there were a further two mortalities recorded after discharge from ICU, reaching a total mortality rate of 80·8% (21/26). Patients with ICU survival >2 weeks had lower rates of HIV infection (P=0·004), less use of inotropic agents during ICU stay (P<0·001) and lower white blood cell counts (P=0·01). After adjusting for clinical variables in the multivariate Cox regression model, diabetes and cryptococcal infection after ICU admission were independent predictors of good long-term prognosis (P=0·015) and HIV infectious status was associated with poor outcome (P=0·012).