Cryptococcal Meningitis: Comparison of Short- (≤ 1 week) versus Longer-duration (> 1 week) Liposomal Amphotericin B Induction Therapy and Factors Associated with Clinical Outcomes in HIV and non-HIV patients

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 Glasgow Outcome Scale (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% vs. 61.5% (P = 0.34), in-hospital mortality 5.0% vs. 5.5% (P = 0.93), and 90-day readmission 25.0% vs. 38.5% (P = 0.24) 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, while 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.