title: A meta-analysis of medical versus surgical therapy for Candida endocarditis.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC 27710, USA. stein022@mc.duke.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Cabell
authors.forename: Vance G
authors.initials: VG
authors.lastname: Fowler
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Li
authors.forename: Aimee K
authors.initials: AK
authors.lastname: Zaas
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Benjamin
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002175:Candida / Q000145:classification / Q000187:drug effects; D002177:Candidiasis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004696:Endocarditis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents