title: Candida infective endocarditis: an observational cohort study with a focus on therapy.
abstract: Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.
authors: Duke University Medical Center, Durham, North Carolina, USA christopher.arnold@duke.edu.
authors: Christopher J
authors: CJ
authors: Arnold
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Melissa
authors: M
authors: Johnson
authors: Harbor-UCLA Medical Center, Los Angeles, California, USA.
authors: Arnold S
authors: AS
authors: Bayer
authors: VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, USA.
authors: Suzanne
authors: S
authors: Bradley
authors: Attikon University General Hospital, Athens, Greece.
authors: Efthymia
authors: E
authors: Giannitsioti
authors: Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: José M
authors: JM
authors: Miró
authors: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Pilar
authors: P
authors: Tornos
authors: Pontchaillou University, Rennes, France.
authors: Pierre
authors: P
authors: Tattevin
authors: Hadassah-Hebrew University, Jerusalem, Israel.
authors: Jacob
authors: J
authors: Strahilevitz
authors: Alfred Hospital and Monash University, Melbourne, Australia.
authors: Denis
authors: D
authors: Spelman
authors: Barwon Health, Geelong, Australia.
authors: Eugene
authors: E
authors: Athan
authors: Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
authors: Francisco
authors: F
authors: Nacinovich
authors: Hospital Universitario Clementino Fraga Filho/UFRJ, Rio de Janeiro, Brazil.
authors: Claudio Q
authors: CQ
authors: Fortes
authors: Instituto Nacional de Cardiologia and Unigranrio, Rio de Janeiro, Brazil.
authors: Cristiane
authors: C
authors: Lamas
authors: University Hospital for Infectious Diseases, Zagreb, Croatia.
authors: Bruno
authors: B
authors: Barsic
authors: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Nuria
authors: N
authors: Fernández-Hidalgo
authors: Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors: Patricia
authors: P
authors: Muñoz
authors: Duke University Medical Center, Durham, North Carolina, USA.
authors: Vivian H
authors: VH
authors: Chu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D003428:Cross Infection / Q000188:drug therapy / Q000401:mortality; D054714:Echinocandins / Q000627:therapeutic use; D004696:Endocarditis / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000666:Amphotericin B
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