A meta-analysis of medical versus surgical therapy for Candida endocarditis.
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.
Steinbach
William J
WJ
Division of Infectious Diseases, Department of Pediatrics, Duke University, Durham, NC 27710, USA. stein022@mc.duke.edu
Perfect
John R
JR
Cabell
Christopher H
CH
Fowler
Vance G
VG
Corey
G Ralph
GR
Li
Jennifer S
JS
Zaas
Aimee K
AK
Benjamin
Daniel K
DK
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
D000935:Antifungal Agents