title: Diagnosis, management and outcome of Candida endocarditis.
abstract: Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of CE remains difficult, non-culture-based tools need to be evaluated. Through the French prospective MYCENDO study (2005-2007), the overall characteristics and risk factors for death from CE were analysed. The contribution of antigen detection (mannan/anti-mannan antibodies and (1,3)-β-d-glucans) and molecular tools was evaluated. Among 30 CE cases, 19 were caused by non-albicans species. Sixteen patients (53%) had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were intravenous drug users; none of them had right-sided CE. Among the 21 patients who were not intravenous drug users, 18 (86%) had healthcare-associated CE. Initial therapy consisted of a combination of antifungals in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow-up was 1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On univariate analysis, patients aged ≥60 years had a higher mortality risk (OR 11, 95% CI 1.2-103.9; p 0.024), whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02-0.7; p 0.03). Among 18 patients screened for both serum mannan/anti-mannan antibodies and (1,3)-β-d-glucans, all had a positive result with at least one of either test at CE diagnosis. Real-time PCR was performed on blood (SeptiFast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens and molecular tools may contribute to earlier CE diagnosis.
authors.affiliation: Université Paris Descartes, AP-HP, Hôpital Necker-Enfants malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, France.
authors.forename: A
authors.initials: A
authors.lastname: Lefort
authors.forename: L
authors.initials: L
authors.lastname: Chartier
authors.forename: B
authors.initials: B
authors.lastname: Sendid
authors.forename: M
authors.initials: M
authors.lastname: Wolff
authors.forename: J-L
authors.initials: JL
authors.lastname: Mainardi
authors.forename: I
authors.initials: I
authors.lastname: Podglajen
authors.forename: M
authors.initials: M
authors.lastname: Desnos-Ollivier
authors.forename: A
authors.initials: A
authors.lastname: Fontanet
authors.forename: S
authors.initials: S
authors.lastname: Bretagne
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000908:Antibodies, Fungal / Q000097:blood; D000935:Antifungal Agents / Q000494:pharmacology; D000946:Antigens, Fungal / Q000032:analysis / Q000276:immunology; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D002175:Candida / Q000187:drug effects / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D002648:Child; D004271:DNA, Fungal / Q000097:blood / Q000235:genetics; D004696:Endocarditis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D005260:Female; D015725:Fluconazole / Q000494:pharmacology; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D011509:Proteoglycans; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood / Q000276:immunology
chemical_list: D000908:Antibodies, Fungal; D000935:Antifungal Agents; D000946:Antigens, Fungal; D004271:DNA, Fungal; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K; D015725:Fluconazole