Original Research

Management of cryptococcal meningitis in a district hospital in KwaZulu-Natal: A clinical audit

Benjamin O. Adeyemi, Andrew Ross
African Journal of Primary Health Care & Family Medicine | Vol 6, No 1 | a672 | DOI: https://doi.org/10.4102/phcfm.v6i1.672 | © 2014 Benjamin O. Adeyemi, Andrew Ross | This work is licensed under CC Attribution 4.0
Submitted: 03 March 2014 | Published: 13 October 2014

About the author(s)

Benjamin O. Adeyemi, Department of Family Medicine, Pietermaritzburg Hospitals Complex and University of KwaZulu-Natal, South Africa
Andrew Ross, Department of Family Medicine, University of KwaZulu-Natal, South Africa


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Abstract

Background: Despite the development of context-specific guidelines, cryptococcal meningitis (CCM) remains a leading cause of death amongst HIV-infected patients. Results from clinical audits in routine practice have shown critical gaps in clinicians’ adherence to recommendations regarding the management of CCM.

Aim: The aim of this study was to review the acute management of CCM at an urban district hospital in KwaZulu-Natal, South Africa with a view to making recommendations for improving care.

Setting: An urban district hospital in KwaZulu-Natal, South Africa.

Methods: A retrospective audit was performed on clinical records of all patients (age > 13 years) admitted to the hospital with a diagnosis of CCM between June 2011 and December 2012.

Results: Measurement of cerebrospinal fluid opening pressure at initial lumbar puncture (LP) was done rarely and only 23.4% of patients had therapeutic LPs. The majority of patients (117/127; 92.1%) received amphotericin B, however, only 19 of the 117 patients (16.2%) completed the 14-day treatment target. Amphotericin B-toxicity monitoring and prevention was suboptimal; however, in-patient referral for HIV counselling and testing was excellent.

Conclusions: The quality of care of CCM based on selected process criteria showed gaps in routine care at the hospital despite the availability of context-specific guidelines. An action plan for improving care was developed based on stakeholders’ feedback. A repeat audit should be conducted in the future in order to evaluate the impact of this plan and to ensure that improvements are sustained.


Keywords

Cryptococcal meningitis; Cryptococcus neoformans; District hospital; KwaZulu-Natal

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Crossref Citations

1. Cryptococcosis Today: It Is Not All About HIV Infection
Jane A. O’Halloran, William G. Powderly, Andrej Spec
Current Clinical Microbiology Reports  vol: 4  issue: 2  first page: 88  year: 2017  
doi: 10.1007/s40588-017-0064-8