Neil M. Ampel, MD reviewing Spec A et al. Clin Infect Dis 2016 Dec 7.

In a retrospective review, an infectious diseases consultation resulted in more-frequent appropriate lumbar punctures, increased use of appropriate antifungal therapy, and lower mortality.

The management of cryptococcosis depends on defining the type of disease and on instituting the correct antifungal therapy. Given the complexity and relative rarity of cryptococcosis, it is reasonable to consider whether having an expert opinion from an infectious diseases clinician results in an improved outcome. To examine this issue, researchers collected data from 147 patients without HIV infection who were diagnosed with cryptococcosis between January 2002 and February 2015 at a single, large tertiary care hospital. Among these, 100 (68%) had an infectious diseases consultation.

Patients who received consultation were significantly more likely to have central nervous system infection (57% vs. 11%) but significantly less likely to have pulmonary disease (27% vs 64%). A lumbar puncture (LP) was appropriately performed in 86% of those with a consultation, compared with 32% without a consultation (P<0.001). Both amphotericin B and 5-fluorocytosine were significantly more likely to be appropriately recommended in the consultation cohort (87% vs. 24% and 57% vs. 16%). After adjustment for clinical factors, 90-day survival was significantly better for those who received a consultation compared with those who did not.

CITATION(S):

Spec A et al. Impact of infectious diseases consultation on mortality of cryptococcal infection in patients without HIV. Clin Infect Dis 2016 Dec 7; [e-pub].

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