Disseminated Cryptococcus neoformans var. grubii infections in intensive care units.
A 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 with Cryptococcus neoformans var. grubii infection 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).
Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin branch, Dou-Liou City, Taiwan.
Y-M
YM
Chuang
S C
SC
Ku
S J
SJ
Liaw
S C
SC
Wu
Y C
YC
Ho
C J
CJ
Yu
P R
PR
Hsueh
D001201:Ascites / Q000150:complications / Q000453:epidemiology; D003428:Cross Infection / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003455:Cryptococcus neoformans; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006331:Heart Diseases / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007362:Intensive Care Units; D007674:Kidney Diseases / Q000150:complications / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D012189:Retrospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000453:epidemiology