Fungal prosthetic valve endocarditis.
Fungal prosthetic valve endocarditis is an unusual cause of endocarditis, yet very important because of its historical poor prognosis. This article will review the incidence, presentation, diagnosis, and treatment results of fungal prosthetic valve endocarditis. In addition, 11 patients at The Cleveland Clinic over the last 16 years were treated with a strategy consisting of aggressive perioperative amphotericin B therapy, radical surgical debridement of all infected tissue and prosthetic valve replacement with biological tissue when possible, as well as the chronic use of oral azole antifungal agents for suppression. This combined approach has resulted in 82% of patients being discharged and a 55% 5-year survival rate. Unfortunately, 36% of patients developed recurrent fungal prosthetic valve endocarditis, at an average of 25.8 months after their first operation for fungal prosthetic valve endocarditis. The use of oral antiazole antifungal agents for suppression may prevent the high incidence of recurrent endocarditis in this patient population.
Muehrcke
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Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, OH 44195.
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001393:Azoles / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004696:Endocarditis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D012008:Recurrence; D015996:Survival Rate
D000935:Antifungal Agents; D001393:Azoles; D000666:Amphotericin B