394. Outcomes in Patients With Disseminated Noncentral Nervous System Cryptococcus

Abstract

BackgroundDifferentiating between localized and disseminated cryptococcal disease is key to the management of this infection, since induction therapy with amphotericin B and flucytosine is warranted in the latter. We compared mortality in disseminated Cryptococcus with non-central nervous system (CNS) involvement, with those with CNS involvement and localized pulmonary disease.MethodsDemographics, predisposing factors, presentation, laboratory values, treatment and outcome data were collected retrospectively on patients hospitalized at an academic tertiary-care hospital for cryptococcal infection from 2002 to 2017. Outcomes were compared between three patient groups based on extra-pulmonary and CNS involvement. Survival analysis was performed using univariate and multivariate Cox Regression with censoring at 90 days.ResultsOf 312 patients identified, 63 (20%) had pulmonary, 154 (49.2%) CNS and 95 (30.4%) had disseminated non-CNS disease. At day 90, 38 (40%) from the disseminated non-CNC group had died, compared with 37 (24%) in the CNS disease and 13 (20.6%) in the pulmonary groups. After adjusting for age ≥55 years, organ transplant, end-stage liver disease (ESLD) and AIDS, 90-day mortality risk was higher in the disseminated non-CNS group compared with the pulmonary (HR 2.97 [95% CI 1.55, 5.7]; P = 0.001) and the CNS disease group (1.84 [1.16, 2.93]; P = 0.009) (Figure 1). Median [IQR] time to diagnosis was 10 [4, 19] days and not significantly different between groups (P = 0.752). Induction therapy for ≥2 weeks was more common in the CNS disease (64.3%) that in the pulmonary (33.3%) or disseminated non-CNS disease group (38.7%) (P = 0.01). Median duration of azole therapy in days was longer (315 [61, 750]) in the CNS disease than in the disseminated non-CNS (184 [23.5, 403.5]) or the pulmonary group (214 [86, 415]) (P = 0.04).ConclusionPatients with disseminated cryptococcal disease without CNS involvement have higher risk for mortality than those with CNS disease. However, management of patient’s disseminated non-CNS cryptococcosis was similar to those with localized pulmonary infection.Figure 1.Survival curve of 312 patients with Cryptococcus infection by localization, adjusted for age ≥55, organ transplant, ESDL, and AIDS.Disclosures All authors: No reported disclosures.