Candida infective endocarditis: an observational cohort study with a focus on therapy.

Published

Journal Article

Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.

Full Text

Duke Authors

Cited Authors

  • Arnold, CJ; Johnson, M; Bayer, AS; Bradley, S; Giannitsioti, E; Miró, JM; Tornos, P; Tattevin, P; Strahilevitz, J; Spelman, D; Athan, E; Nacinovich, F; Fortes, CQ; Lamas, C; Barsic, B; Fernández-Hidalgo, N; Muñoz, P; Chu, VH

Published Date

  • April 2015

Published In

Volume / Issue

  • 59 / 4

Start / End Page

  • 2365 - 2373

PubMed ID

  • 25645855

Pubmed Central ID

  • 25645855

Electronic International Standard Serial Number (EISSN)

  • 1098-6596

Digital Object Identifier (DOI)

  • 10.1128/AAC.04867-14

Language

  • eng

Conference Location

  • United States