Management, Outcomes, and Predictors of Mortality of Cryptococcus Infection in Patients Without HIV: A Multicenter Study in 46 Hospitals in Australia and New Zealand.
Background Limited data exist regarding outcomes of cryptococcosis in patients without human immunodeficiency virus (HIV), and few studies have compared outcomes of Cryptococcus gattii versus Cryptococcus neoformans infection. Methods We conducted a retrospective study in 46 Australian and New Zeala...
| Publicado en: | Clinical Infectious Diseases Vol. 80; no. 4; pp. 817 - 826 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
4/15/2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=184862014&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 184862014 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10584838 46X jtl: Clinical Infectious Diseases issn: 10584838 maglogo: N pubinfo: dt: 4/15/2025 vid: 80 iid: 4 pid: 622 pub: Oxford University Press / USA artinfo: ui: 184862014 184862014 184862014 10.1093/cid/ciae630 184862014 ppf: 817 ppct: 9 formats: tig: atl: Management, Outcomes, and Predictors of Mortality of Cryptococcus Infection in Patients Without HIV: A Multicenter Study in 46 Hospitals in Australia and New Zealand. aug: au: Coussement, Julien Heath, Christopher H Roberts, Matthew B Lane, Rebekah J Spelman, Tim Smibert, Olivia C Longhitano, Anthony Morrissey, C Orla Nield, Blake Tripathy, Monica Davis, Joshua S Kennedy, Karina J Lynar, Sarah A Crawford, Lucy C Crawford, Simeon J Smith, Benjamin J Gador-Whyte, Andrew P Haywood, Rose Mahony, Andrew A Howard, Julia C affil: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia sug: subj: Cryptococcosis Therapy Cryptococcosis Mortality Mortality Risk Factors Risk Assessment Evaluation Treatment Outcomes Evaluation Hospitals Australia Hospitals New Zealand Human Multicenter Studies Retrospective Design Australia New Zealand Univariate Statistics Cox Proportional Hazards Model Descriptive Statistics Data Analysis Software Confidence Intervals Odds Ratio Male Female Middle Age Aged Aged, 80 and Over Middle Aged: 45-64 years Aged: 65+ years Aged, 80 & over Male Female ab: Background Limited data exist regarding outcomes of cryptococcosis in patients without human immunodeficiency virus (HIV), and few studies have compared outcomes of Cryptococcus gattii versus Cryptococcus neoformans infection. Methods We conducted a retrospective study in 46 Australian and New Zealand hospitals to determine the outcomes of cryptococcosis in patients without HIV diagnosed between 2015 and 2019 and compared outcomes of C. gattii versus C. neoformans infections. Multivariable analysis identified predictors of mortality within 1 year. Results Of 426 patients, 1-year all-cause mortality was 21%. Cryptococcus gattii infection was associated with lower mortality than C. neoformans (adjusted odds ratio [OR], 0.47; 95% confidence interval [CI],.23–.95), while severe neurological symptoms at presentation were the strongest predictor of death (adjusted OR, 8.46; 95% CI, 2.99–23.98). Almost all (99.5%) patients with central nervous system (CNS) infection received induction antifungal therapy versus 27.7% with isolated pulmonary cryptococcosis. The most common regimen in CNS disease was liposomal amphotericin B with flucytosine (93.8%; mean duration, 31 ± 13 days). Among patients with CNS cryptococcosis, C. gattii infection was associated with higher risk of immune reconstitution inflammatory response (C-IRIS) than C. neoformans (21% versus 3%, P <.001). Nineteen patients received amphotericin B-based re-induction therapy for suspected relapse, but none had microbiological relapse. Serum cryptococcal antigen positivity and lung imaging abnormalities resolved slowly (resolution at 1 year in 25% and 34% of patients, respectively). Conclusions Compared with C. neoformans , C. gattii infection demonstrated lower mortality but higher C-IRIS risk in CNS infection. Severe neurological symptoms were the strongest predictor of mortality. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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