Need for Change in the Quality of Antimicrobial Stewardship Team Recommendations Highlighted by a Case Report of Cryptococcus neoformans Meningoencephalitis

Abstract

A Japanese man in his 80s was admitted to a rural hospital for a left femoral neck fracture. Blood culture results revealed the presence of yeast-like fungi; although treatment with antifungal agents was recommended by the antimicrobial stewardship team (AST), it was not initiated. One month later, the patient developed altered mental status and hyponatremia. Cerebrospinal fluid (CSF) analysis revealed increased cell counts (156/μL) and decreased glucose levels. The CSF culture was positive for Cryptococcus neoformans, based on which we made the diagnosis of cryptococcal meningoencephalitis and initiated appropriate therapy. After 6 weeks of induction therapy with liposomal-amphotericin B and flucytosine, followed by 8 weeks of consolidation therapy with fluconazole, the patient is currently receiving maintenance therapy. In the current case, the AST failed to assist in the early treatment and follow-up of the patient's clinical course; however, with improvement in the quality of interventions recommended by the AST, opportunities for discussions with physicians are increasing, and repeated follow-up of cases is being facilitated. Improvements in AST interventions would be beneficial, especially in rural settings with a paucity of infectious disease doctors.