Adherence of Health Care Providers to Published Practice Guidelines for the Management of Cryptococcal Disease

(See the editorial commentary by Pappas on pages 480–2) Meningitis due to Cryptococcus neoformans may be associ-ated with elevated intracranial pressure (ICP), but manage-ment of this complication is often overlooked. We retro-spectively analyzed 39 consecutive patients with cases of culture-proven, community-acquired meningitis and ascer-tained adherence to Infectious Diseases Society of America (IDSA) practice guidelines for management of cryptococcal meningitis. Of these 39 patients, 26 (67%) had infection due to C. neoformans. Cerebrospinal fluid opening pressure had been measured for 13 (50%) of these 26 patients, and major deviations from the guidelines with respect to ICP manage-ment were observed in the care of 14 (54%). Seven (50%) of these 14 patients developed neuropathies during therapy, compared with 1 of the 5 patients whose care had minor or no deviations from the guidelines (). Major depar-Pp.024 tures from the IDSA guidelines for management of ICP due to C. neoformans meningitis are common and can be asso-ciated with neurological injury during therapy. Cryptococcus neoformans is a major cause of meningitis in im-munocompromised patients [1]. Cryptococcal meningitis is frequently associated with elevated intracranial pressure (ICP). Pressures of 250 mm H2O correlate with a higher pathogen burden, a higher incidence of neuropathies, and decreased sur-vival [2]. Elevated ICP can be managed with removal of CS