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Cryptococcal Meningitis: Comparison of Short- (≤ 1 Week) Versus Longer-duration (> 1 Week) Liposomal Amphotericin B
Sun O Park1, Matthew A Stack2, Ty C Drake3
1Division of Infectious Disease, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Background:
Shorter induction regimens for cryptococcal meningitis (CM) are being proposed, but data from resource-rich countries are limited. We compared clinical outcomes between short- (≤ 1 week) and longer-duration (> 1 week) of liposomal amphotericin B (L-AmB) induction therapy and investigated factors associated with clinical outcomes at a United States medical center.
Methods:
In this retrospective study, cases of CM were identified by a positive cerebrospinal fluid (CSF) culture for Cryptococcus, cryptococcal antigen (CrAg), or India ink stain during 2016-2023. Clinical characteristics and outcomes including Glasgow Outcome Scale (GOS) at discharge, in-hospital mortality, and 90-day readmission between short-duration and longer-duration of L-AmB induction therapy were compared. Multivariable logistic regression was used to identify predictors of GOS at discharge and 90-day readmission.
Results:
Of 129 patients, 20 were in the short-duration (11 patients with HIV) and 109 in the longer-duration L-AmB group (72 with HIV). The short-duration group was less severely ill at baseline. Unfavorable GOS at discharge was 50.0% versus 61.5% (P = .34), in-hospital mortality 5.0% versus 5.5% (P = .93), and 90-day readmission 25.0% versus 38.5% (P = .24) in the short-duration and longer-duration groups, respectively. In multivariable analyses, higher CSF CrAg titer, acute kidney injury, and absence of photophobia were associated with unfavorable GOS at discharge, whereas L-AmB duration was not significantly associated. Association between L-AmB duration and 90-day readmission was inconsistent.
Conclusions:
Short-duration L-AmB may have comparable outcomes to longer-duration in this cohort; further studies are needed to confirm these findings.
Insights
Shorter induction regimens using liposomal amphotericin B (L-AmB) for cryptococcal meningitis (CM) showed similar outcomes to longer durations in a US study. Further research is needed to confirm these findings for CM treatment.
Area of Science:
- Infectious Diseases
- Mycology
- Clinical Pharmacology
Background:
- Cryptococcal meningitis (CM) treatment guidelines are evolving, with shorter induction regimens proposed.
- Limited data exist on shorter induction regimens from resource-rich settings.
- This study evaluates liposomal amphotericin B (L-AmB) induction therapy duration for CM in the US.
Purpose of the Study:
- Compare clinical outcomes between short (≤1 week) and long (>1 week) L-AmB induction therapy for CM.
- Identify factors associated with clinical outcomes in CM patients receiving L-AmB.
- Assess the impact of L-AmB induction duration on patient outcomes.
Main Methods:
- Retrospective study of 129 CM patients (2016-2023) with positive CSF cultures or CrAg.
- Compared outcomes: Glasgow Outcome Scale (GOS) at discharge, in-hospital mortality, 90-day readmission.
- Used multivariable logistic regression to identify predictors of GOS and readmission.
Main Results:
- No significant differences in unfavorable GOS (50.0% vs 61.5%), in-hospital mortality (5.0% vs 5.5%), or 90-day readmission (25.0% vs 38.5%) between short- and long-duration L-AmB groups.
- L-AmB duration was not significantly associated with unfavorable GOS at discharge.
- Higher CSF CrAg titer, AKI, and absence of photophobia predicted unfavorable GOS.
Conclusions:
- Short-duration L-AmB induction therapy may yield comparable outcomes to longer durations for CM in this US cohort.
- Further studies are warranted to validate these findings and inform clinical practice.
- Factors beyond L-AmB duration influence CM patient outcomes.
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