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A meta-analysis of medical versus surgical therapy for Candida endocarditis.

Publication ,  Journal Article
Steinbach, WJ; Perfect, JR; Cabell, CH; Fowler, VG; Corey, GR; Li, JS; Zaas, AK; Benjamin, DK
Published in: J Infect
October 2005

OBJECTIVES: The optimal management of Candida infective endocarditis (IE) is unknown. METHODS: We reviewed all 879 cases of Candida IE reported from 1966-2002 in the peer-reviewed literature to better understand the role of medical and surgical therapies. This review included 163 patients from 105 reports that met our inclusion criteria: 31 cases treated with antifungal monotherapy, 25 cases treated with medical antifungal combination therapy, and 107 cases treated with adjunctive surgical plus medical antifungal therapy. We also used meta-analytic techniques to evaluate 22 observational case-series (72 patients) of the 105 reports with two or more patients with definite Candida IE. RESULTS: We found that in patients who underwent adjunctive surgery there was a lower reported proportion of deaths [prevalence odds ratio (POR)=0.56; 95% confidence interval (CI)=0.16, 1.99)]. Higher mortality was noted in patients treated prior to 1980 (POR=2.03; 95% CI=0.55, 7.61), treated with antifungal monotherapy (POR=1.49; 95% CI=0.39, 5.81), infected with Candida parapsilosis (POR=1.51; 95% CI=0.41, 5.52), or with left-sided endocarditis (POR=2.36; 95% CI=0.55, 10.07). CONCLUSIONS: Medical antifungal therapy of Candida IE is poorly characterized, and recent antifungal developments lend promise for those patients who cannot undergo surgery.

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Published In

J Infect

DOI

EISSN

1532-2742

Publication Date

October 2005

Volume

51

Issue

3

Start / End Page

230 / 247

Location

England

Related Subject Headings

  • Treatment Outcome
  • Microbiology
  • Infant, Newborn
  • Infant
  • Humans
  • Endocarditis
  • Child, Preschool
  • Child
  • Candidiasis
  • Candida
 

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Steinbach, W. J., Perfect, J. R., Cabell, C. H., Fowler, V. G., Corey, G. R., Li, J. S., … Benjamin, D. K. (2005). A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect, 51(3), 230–247. https://doi.org/10.1016/j.jinf.2004.10.016
Steinbach, William J., John R. Perfect, Christopher H. Cabell, Vance G. Fowler, G Ralph Corey, Jennifer S. Li, Aimee K. Zaas, and Daniel K. Benjamin. “A meta-analysis of medical versus surgical therapy for Candida endocarditis.J Infect 51, no. 3 (October 2005): 230–47. https://doi.org/10.1016/j.jinf.2004.10.016.
Steinbach WJ, Perfect JR, Cabell CH, Fowler VG, Corey GR, Li JS, et al. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect. 2005 Oct;51(3):230–47.
Steinbach, William J., et al. “A meta-analysis of medical versus surgical therapy for Candida endocarditis.J Infect, vol. 51, no. 3, Oct. 2005, pp. 230–47. Pubmed, doi:10.1016/j.jinf.2004.10.016.
Steinbach WJ, Perfect JR, Cabell CH, Fowler VG, Corey GR, Li JS, Zaas AK, Benjamin DK. A meta-analysis of medical versus surgical therapy for Candida endocarditis. J Infect. 2005 Oct;51(3):230–247.
Journal cover image

Published In

J Infect

DOI

EISSN

1532-2742

Publication Date

October 2005

Volume

51

Issue

3

Start / End Page

230 / 247

Location

England

Related Subject Headings

  • Treatment Outcome
  • Microbiology
  • Infant, Newborn
  • Infant
  • Humans
  • Endocarditis
  • Child, Preschool
  • Child
  • Candidiasis
  • Candida