title: Candida infective endocarditis.
abstract: Candida infective endocarditis (IE) is uncommon but often fatal. Most epidemiologic data are derived from small case series or case reports. This study was conducted to explore the epidemiology, treatment patterns, and outcomes of patients with Candida IE. We compared 33 Candida IE cases to 2,716 patients with non-fungal IE in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). Patients were enrolled and the data collected from June 2000 until August 2005. We noted that patients with Candida IE were more likely to have prosthetic valves (p < 0.001), short-term indwelling catheters (p < 0.0001), and have healthcare-associated infections (p < 0.001). The reasons for surgery differed between the two groups: myocardial abscess (46.7% vs. 22.2%, p = 0.026) and persistent positive blood cultures (33.3% vs. 9.9%, p = 0.003) were more common among those with Candida IE. Mortality at discharge was higher in patients with Candida IE (30.3%) when compared to non-fungal cases (17%, p = 0.046). Among Candida patients, mortality was similar in patients who received combination surgical and antifungal therapy versus antifungal therapy alone (33.3% vs. 27.8%, p = 0.26). New antifungal drugs, particularly echinocandins, were used frequently. These multi-center data suggest distinct epidemiologic features of Candida IE when compared to non-fungal cases. Indications for surgical intervention are different and mortality is increased. Newer antifungal treatment options are increasingly used. Large, multi-center studies are needed to help better define Candida IE.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA. jbaddley@uab.edu
authors.forename: J W
authors.initials: JW
authors.lastname: Baddley
authors.forename: D K
authors.initials: DK
authors.lastname: Benjamin
authors.forename: M
authors.initials: M
authors.lastname: Patel
authors.forename: J
authors.initials: J
authors.lastname: Miró
authors.forename: E
authors.initials: E
authors.lastname: Athan
authors.forename: B
authors.initials: B
authors.lastname: Barsic
authors.forename: E
authors.initials: E
authors.lastname: Bouza
authors.forename: L
authors.initials: L
authors.lastname: Clara
authors.forename: T
authors.initials: T
authors.lastname: Elliott
authors.forename: Z
authors.initials: Z
authors.lastname: Kanafani
authors.forename: J
authors.initials: J
authors.lastname: Klein
authors.forename: S
authors.initials: S
authors.lastname: Lerakis
authors.forename: D
authors.initials: D
authors.lastname: Levine
authors.forename: D
authors.initials: D
authors.lastname: Spelman
authors.forename: E
authors.initials: E
authors.lastname: Rubinstein
authors.forename: P
authors.initials: P
authors.lastname: Tornos
authors.forename: A J
authors.initials: AJ
authors.lastname: Morris
authors.forename: P
authors.initials: P
authors.lastname: Pappas
authors.forename: V G
authors.initials: VG
authors.lastname: Fowler
authors.forename: V H
authors.initials: VH
authors.lastname: Chu
authors.forename: C
authors.initials: C
authors.lastname: Cabell
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D002408:Catheters, Indwelling; D003428:Cross Infection; D004696:Endocarditis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents