Clinical Characteristics and Outcomes in Patients With Cryptococcaemia From a Large Population-Based Cohort

Area of Science:

• Medical Mycology
• Infectious Diseases
• Epidemiology

Background:

• Cryptococcus bloodstream infections (BSIs), or cryptococcaemia, are severe opportunistic infections with high mortality rates.
• These infections predominantly affect immunocompromised individuals or those with end-stage organ disease.
• Limited population-based studies exist on infection trends, host factors, geographic variations, antifungal resistance, and clinical outcomes.

Purpose of the Study:

• To examine trends and identify risk factors associated with mortality in cryptococcaemia over a 20-year period.
• To investigate the impact of host factors, geography, and antifungal resistance on clinical outcomes.
• To inform strategies for managing and preventing cryptococcal infections.

Main Methods:

• Retrospective analysis of blood cultures positive for Cryptococcus species from January 1, 2000, to December 31, 2019.
• Collection and analysis of clinical, microbiological, and outcome data.
• Survival analyses to determine associations between characteristics and mortality.

Main Results:

• 118 episodes of cryptococcaemia (115 patients) were identified; Cryptococcus neoformans complex caused 98% of infections.
• Overall 30-day mortality was 34%, significantly higher in non-HIV-associated cases (41.7%) compared to HIV-associated cases (12.5%).
• Increasing fluconazole minimum inhibitory concentration (MIC) values in C. neoformans complex correlated with increased mortality; 46% of isolates with MIC ≥ 8 mg/L were in the most recent 5-year period.

Conclusions:

• Cryptococcus BSI is highly lethal, particularly in non-HIV infected individuals.
• Blood culture collection is crucial for diagnosing cryptococcal infections and guiding treatment.
• Continued surveillance of fluconazole susceptibility is essential due to emerging resistance patterns.