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 (385%), diabetes mellitus (269%) and HIV infection (192%). The most frequently identified sites of infection were blood (615%), cerebrospinal fluid (385%) and airways (346%). The mean Acute Physiologic and Chronic Health Evaluation II score at ICU admission was 2246. The ICU mortality rate in these patients was 731% (19/26) and there were a further two mortalities recorded after discharge from ICU, reaching a total mortality rate of 808% (21/26). Patients with ICU survival >2 weeks had lower rates of HIV infection (P=0004), less use of inotropic agents during ICU stay (P<0001) and lower white blood cell counts (P=001). 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=0015) and HIV infectious status was associated with poor outcome (P=0012).