Clinical characteristics and mortality risks among critically ill patients with culture-proven coccidioidomycosis: A multi-center study in an endemic region

Abstract

Background Coccidioidomycosis is an endemic mycosis in the southwestern United States. While most infections are mild, severe cases can be devastating. We aimed to describe clinical characteristics and the mortality risks of intensive care unit (ICU) patients with culture-proven coccidioidomycosis. Methods We performed a retrospective chart review of ICU patients with positive Coccidioides spp. culture in a large healthcare system in Arizona between October 1, 2017, and July 1, 2022. All data was entered in REDCap. Results One-hundred and forty-five patients were identified and included. The median age was 51 years, with the majority (69%) male and 39% non-Hispanic White. Most, 104 (72%) had pulmonary coccidioidomycosis, and 41 patients had extrapulmonary disease (17 meningitis, 13 fungemia, 10 musculoskeletal disease, and 4 pericardial or aortic involvement). Seventy (48%) patients died during hospitalization, and most patients (91%) received antifungal therapy during hospitalization. In the multivariate logistic regression model, Age ≥60 (OR 7.0, 95%CI 2.6 - 18.8), cirrhosis (OR 13.1, 95%CI 1.6 - 108.8), and mechanical ventilation or vasopressor support (OR 15.4, 95% CI 3.9 - 59.6) were independently associated with increased all-cause mortality, but pre-ICU antifungal use had statistically insignificant mortality risk association (OR 0.5, 95% CI 0.2 -1.2). Conclusions In our study of ICU coccidioidomycosis patients with multiple comorbidities, the mortality rate was high. Older age, cirrhosis, and mechanical ventilation or vasopressor support were significantly associated with high mortality. Future studies to evaluate those risk factors and the efficacy of rapid diagnosis and early therapy in high-risk patients are recommended.