Candida infective endocarditis: An observational cohort study with a focus on therapy

Christopher J. Arnold; Melissa Johnson; Arnold S. Bayer; Suzanne Bradley; Efthymia Giannitsioti; José M. Miró; Pilar Tornos; Pierre Tattevin; Jacob Strahilevitz; Denis Spelman; Eugene Athan; Francisco Nacinovich; Claudio Q. Fortes; Cristiane Lamas; Bruno Barsic; Nuria Fernández-Hidalgo; Patricia Muñoz; Vivian H. Chu; Liliana Clara; Marisa Sanchez; José Casabé; Claudia Cortes; Pablo Fernandez Oses; Ricardo Ronderos; Adriana Sucari; Jorge Thierer; Javier Altclas; Silvia Kogan; Owen Harris; Karina Kennedy; Ren Tan; David Gordon; Lito Papanicolas; Tony Korman; Despina Kotsanas; Robyn Dever; Phillip Jones; Pam Konecny; Richard Lawrence; David Rees; Suzanne Ryan; Michael P. Feneley; John Harkness; Jeffrey Post; Porl Reinbott; Rainer Gattringer; Franz Wiesbauer; Adriana Ribas Andrade; Ana Cláudia Passos De Brito; Armenio Costa Guimarães; Max Grinberg; Alfredo José Mansur; Rinaldo Focaccia Siciliano; Tania Mara Varejao Strabelli; Marcelo Luiz Campos Vieira; Regina Aparecida De Medeiros Tranchesi; Marcelo Goulart Paiva; Claudio Q. Fortes; Auristela De Oliveira Ramos; Clara Weksler; Giovanna Ferraiuoli; Wilma Golebiovski; James A. Karlowsky; Yoav Keynan; Andrew M. Morris; Ethan Rubinstein; Sandra Braun Jones; Patricia Garcia; M. Cereceda; Alberto Fica; Rodrigo Montagna Mella; Ricardo Fernandez; Liliana Franco; Javier Gonzalez; Astrid Natalia Jaramillo; Suzana Bukovski; Vladimir Krajinovic; Ana Pangercic; Igor Rudez; Josip Vincelj; Tomas Freiberger; Jiri Pol; Barbora Zaloudikova; Zainab Ashour; Amani El Kholy; Marwa Mishaal; Dina Osama; Hussien Rizk; Neijla Aissa; Corentine Alauzet; Francois Alla; Catherine Campagnac; Thanh Doco-Lecompte; Christine Selton-Suty; Jean Paul Casalta; Pierre Edouard Fournier; Gilbert Habib; Didier Raoult; Franck Thuny; Francois Delahaye

doi:10.1128/AAC.04867-14

Candida infective endocarditis: An observational cohort study with a focus on therapy

Christopher J. Arnold, Melissa Johnson, Arnold S. Bayer, Suzanne Bradley, Efthymia Giannitsioti, José M. Miró, Pilar Tornos, Pierre Tattevin, Jacob Strahilevitz, Denis Spelman, Eugene Athan, Francisco Nacinovich, Claudio Q. Fortes, Cristiane Lamas, Bruno Barsic, Nuria Fernández-Hidalgo, Patricia Muñoz, Vivian H. Chu, Liliana Clara, Marisa SanchezJosé Casabé, Claudia Cortes, Pablo Fernandez Oses, Ricardo Ronderos, Adriana Sucari, Jorge Thierer, Javier Altclas, Silvia Kogan, Owen Harris, Karina Kennedy, Ren Tan, David Gordon, Lito Papanicolas, Tony Korman, Despina Kotsanas, Robyn Dever, Phillip Jones, Pam Konecny, Richard Lawrence, David Rees, Suzanne Ryan, Michael P. Feneley, John Harkness, Jeffrey Post, Porl Reinbott, Rainer Gattringer, Franz Wiesbauer, Adriana Ribas Andrade, Ana Cláudia Passos De Brito, Armenio Costa Guimarães, Max Grinberg, Alfredo José Mansur, Rinaldo Focaccia Siciliano, Tania Mara Varejao Strabelli, Marcelo Luiz Campos Vieira, Regina Aparecida De Medeiros Tranchesi, Marcelo Goulart Paiva, Claudio Q. Fortes, Auristela De Oliveira Ramos, Clara Weksler, Giovanna Ferraiuoli, Wilma Golebiovski, James A. Karlowsky, Yoav Keynan, Andrew M. Morris, Ethan Rubinstein, Sandra Braun Jones, Patricia Garcia, M. Cereceda, Alberto Fica, Rodrigo Montagna Mella, Ricardo Fernandez, Liliana Franco, Javier Gonzalez, Astrid Natalia Jaramillo, Suzana Bukovski, Vladimir Krajinovic, Ana Pangercic, Igor Rudez, Josip Vincelj, Tomas Freiberger, Jiri Pol, Barbora Zaloudikova, Zainab Ashour, Amani El Kholy, Marwa Mishaal, Dina Osama, Hussien Rizk, Neijla Aissa, Corentine Alauzet, Francois Alla, Catherine Campagnac, Thanh Doco-Lecompte, Christine Selton-Suty, Jean Paul Casalta, Pierre Edouard Fournier, Gilbert Habib, Didier Raoult, Franck Thuny, Francois Delahaye

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

45 Citations (Scopus)

Abstract

Copyright © 2015, American Society for Microbiology. 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.

Original language	English
Pages (from-to)	2365-2373
Journal	Antimicrobial Agents and Chemotherapy
Volume	59
Issue number	4
DOIs	https://doi.org/10.1128/AAC.04867-14
Publication status	Published - 1 Apr 2015

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10.1128/AAC.04867-14

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Arnold, C. J., Johnson, M., Bayer, A. S., Bradley, S., Giannitsioti, E., Miró, J. M., Tornos, P., Tattevin, P., Strahilevitz, J., Spelman, D., Athan, E., Nacinovich, F., Fortes, C. Q., Lamas, C., Barsic, B., Fernández-Hidalgo, N., Muñoz, P., Chu, V. H., Clara, L., ... Delahaye, F. (2015). Candida infective endocarditis: An observational cohort study with a focus on therapy. Antimicrobial Agents and Chemotherapy, 59(4), 2365-2373. https://doi.org/10.1128/AAC.04867-14

Arnold, Christopher J. ; Johnson, Melissa ; Bayer, Arnold S. ; Bradley, Suzanne ; Giannitsioti, Efthymia ; Miró, José M. ; Tornos, Pilar ; Tattevin, Pierre ; Strahilevitz, Jacob ; Spelman, Denis ; Athan, Eugene ; Nacinovich, Francisco ; Fortes, Claudio Q. ; Lamas, Cristiane ; Barsic, Bruno ; Fernández-Hidalgo, Nuria ; Muñoz, Patricia ; Chu, Vivian H. ; Clara, Liliana ; Sanchez, Marisa ; Casabé, José ; Cortes, Claudia ; Oses, Pablo Fernandez ; Ronderos, Ricardo ; Sucari, Adriana ; Thierer, Jorge ; Altclas, Javier ; Kogan, Silvia ; Harris, Owen ; Kennedy, Karina ; Tan, Ren ; Gordon, David ; Papanicolas, Lito ; Korman, Tony ; Kotsanas, Despina ; Dever, Robyn ; Jones, Phillip ; Konecny, Pam ; Lawrence, Richard ; Rees, David ; Ryan, Suzanne ; Feneley, Michael P. ; Harkness, John ; Post, Jeffrey ; Reinbott, Porl ; Gattringer, Rainer ; Wiesbauer, Franz ; Andrade, Adriana Ribas ; De Brito, Ana Cláudia Passos ; Guimarães, Armenio Costa ; Grinberg, Max ; Mansur, Alfredo José ; Siciliano, Rinaldo Focaccia ; Strabelli, Tania Mara Varejao ; Vieira, Marcelo Luiz Campos ; De Medeiros Tranchesi, Regina Aparecida ; Paiva, Marcelo Goulart ; Fortes, Claudio Q. ; De Oliveira Ramos, Auristela ; Weksler, Clara ; Ferraiuoli, Giovanna ; Golebiovski, Wilma ; Karlowsky, James A. ; Keynan, Yoav ; Morris, Andrew M. ; Rubinstein, Ethan ; Jones, Sandra Braun ; Garcia, Patricia ; Cereceda, M. ; Fica, Alberto ; Mella, Rodrigo Montagna ; Fernandez, Ricardo ; Franco, Liliana ; Gonzalez, Javier ; Jaramillo, Astrid Natalia ; Bukovski, Suzana ; Krajinovic, Vladimir ; Pangercic, Ana ; Rudez, Igor ; Vincelj, Josip ; Freiberger, Tomas ; Pol, Jiri ; Zaloudikova, Barbora ; Ashour, Zainab ; Kholy, Amani El ; Mishaal, Marwa ; Osama, Dina ; Rizk, Hussien ; Aissa, Neijla ; Alauzet, Corentine ; Alla, Francois ; Campagnac, Catherine ; Doco-Lecompte, Thanh ; Selton-Suty, Christine ; Casalta, Jean Paul ; Fournier, Pierre Edouard ; Habib, Gilbert ; Raoult, Didier ; Thuny, Franck ; Delahaye, Francois. / Candida infective endocarditis: An observational cohort study with a focus on therapy. In: Antimicrobial Agents and Chemotherapy. 2015 ; Vol. 59, No. 4. pp. 2365-2373.

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title = "Candida infective endocarditis: An observational cohort study with a focus on therapy",

abstract = "Copyright {\textcopyright} 2015, American Society for Microbiology. 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.",

author = "Arnold, {Christopher J.} and Melissa Johnson and Bayer, {Arnold S.} and Suzanne Bradley and Efthymia Giannitsioti and Mir{\'o}, {Jos{\'e} M.} and Pilar Tornos and Pierre Tattevin and Jacob Strahilevitz and Denis Spelman and Eugene Athan and Francisco Nacinovich and Fortes, {Claudio Q.} and Cristiane Lamas and Bruno Barsic and Nuria Fern{\'a}ndez-Hidalgo and Patricia Mu{\~n}oz and Chu, {Vivian H.} and Liliana Clara and Marisa Sanchez and Jos{\'e} Casab{\'e} and Claudia Cortes and Oses, {Pablo Fernandez} and Ricardo Ronderos and Adriana Sucari and Jorge Thierer and Javier Altclas and Silvia Kogan and Owen Harris and Karina Kennedy and Ren Tan and David Gordon and Lito Papanicolas and Tony Korman and Despina Kotsanas and Robyn Dever and Phillip Jones and Pam Konecny and Richard Lawrence and David Rees and Suzanne Ryan and Feneley, {Michael P.} and John Harkness and Jeffrey Post and Porl Reinbott and Rainer Gattringer and Franz Wiesbauer and Andrade, {Adriana Ribas} and {De Brito}, {Ana Cl{\'a}udia Passos} and Guimar{\~a}es, {Armenio Costa} and Max Grinberg and Mansur, {Alfredo Jos{\'e}} and Siciliano, {Rinaldo Focaccia} and Strabelli, {Tania Mara Varejao} and Vieira, {Marcelo Luiz Campos} and {De Medeiros Tranchesi}, {Regina Aparecida} and Paiva, {Marcelo Goulart} and Fortes, {Claudio Q.} and {De Oliveira Ramos}, Auristela and Clara Weksler and Giovanna Ferraiuoli and Wilma Golebiovski and Karlowsky, {James A.} and Yoav Keynan and Morris, {Andrew M.} and Ethan Rubinstein and Jones, {Sandra Braun} and Patricia Garcia and M. Cereceda and Alberto Fica and Mella, {Rodrigo Montagna} and Ricardo Fernandez and Liliana Franco and Javier Gonzalez and Jaramillo, {Astrid Natalia} and Suzana Bukovski and Vladimir Krajinovic and Ana Pangercic and Igor Rudez and Josip Vincelj and Tomas Freiberger and Jiri Pol and Barbora Zaloudikova and Zainab Ashour and Kholy, {Amani El} and Marwa Mishaal and Dina Osama and Hussien Rizk and Neijla Aissa and Corentine Alauzet and Francois Alla and Catherine Campagnac and Thanh Doco-Lecompte and Christine Selton-Suty and Casalta, {Jean Paul} and Fournier, {Pierre Edouard} and Gilbert Habib and Didier Raoult and Franck Thuny and Francois Delahaye",

year = "2015",

month = apr,

day = "1",

doi = "10.1128/AAC.04867-14",

language = "English",

volume = "59",

pages = "2365--2373",

journal = "Antimicrobial Agents and Chemotherapy",

issn = "0066-4804",

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Arnold, CJ, Johnson, M, Bayer, AS, Bradley, S, Giannitsioti, E, Miró, JM, Tornos, P, Tattevin, P, Strahilevitz, J, Spelman, D, Athan, E, Nacinovich, F, Fortes, CQ, Lamas, C, Barsic, B, Fernández-Hidalgo, N, Muñoz, P, Chu, VH, Clara, L, Sanchez, M, Casabé, J, Cortes, C, Oses, PF, Ronderos, R, Sucari, A, Thierer, J, Altclas, J, Kogan, S, Harris, O, Kennedy, K, Tan, R, Gordon, D, Papanicolas, L, Korman, T, Kotsanas, D, Dever, R, Jones, P, Konecny, P, Lawrence, R, Rees, D, Ryan, S, Feneley, MP, Harkness, J, Post, J, Reinbott, P, Gattringer, R, Wiesbauer, F, Andrade, AR, De Brito, ACP, Guimarães, AC, Grinberg, M, Mansur, AJ, Siciliano, RF, Strabelli, TMV, Vieira, MLC, De Medeiros Tranchesi, RA, Paiva, MG, Fortes, CQ, De Oliveira Ramos, A, Weksler, C, Ferraiuoli, G, Golebiovski, W, Karlowsky, JA, Keynan, Y, Morris, AM, Rubinstein, E, Jones, SB, Garcia, P, Cereceda, M, Fica, A, Mella, RM, Fernandez, R, Franco, L, Gonzalez, J, Jaramillo, AN, Bukovski, S, Krajinovic, V, Pangercic, A, Rudez, I, Vincelj, J, Freiberger, T, Pol, J, Zaloudikova, B, Ashour, Z, Kholy, AE, Mishaal, M, Osama, D, Rizk, H, Aissa, N, Alauzet, C, Alla, F, Campagnac, C, Doco-Lecompte, T, Selton-Suty, C, Casalta, JP, Fournier, PE, Habib, G, Raoult, D, Thuny, F & Delahaye, F 2015, 'Candida infective endocarditis: An observational cohort study with a focus on therapy', Antimicrobial Agents and Chemotherapy, vol. 59, no. 4, pp. 2365-2373. https://doi.org/10.1128/AAC.04867-14

Candida infective endocarditis: An observational cohort study with a focus on therapy. / Arnold, Christopher J.; Johnson, Melissa; Bayer, Arnold S.; Bradley, Suzanne; Giannitsioti, Efthymia; Miró, José M.; Tornos, Pilar; Tattevin, Pierre; Strahilevitz, Jacob; Spelman, Denis; Athan, Eugene; Nacinovich, Francisco; Fortes, Claudio Q.; Lamas, Cristiane; Barsic, Bruno; Fernández-Hidalgo, Nuria; Muñoz, Patricia; Chu, Vivian H.; Clara, Liliana; Sanchez, Marisa; Casabé, José; Cortes, Claudia; Oses, Pablo Fernandez; Ronderos, Ricardo; Sucari, Adriana; Thierer, Jorge; Altclas, Javier; Kogan, Silvia; Harris, Owen; Kennedy, Karina; Tan, Ren; Gordon, David; Papanicolas, Lito; Korman, Tony; Kotsanas, Despina; Dever, Robyn; Jones, Phillip; Konecny, Pam; Lawrence, Richard; Rees, David; Ryan, Suzanne; Feneley, Michael P.; Harkness, John; Post, Jeffrey; Reinbott, Porl; Gattringer, Rainer; Wiesbauer, Franz; Andrade, Adriana Ribas; De Brito, Ana Cláudia Passos; Guimarães, Armenio Costa; Grinberg, Max; Mansur, Alfredo José; Siciliano, Rinaldo Focaccia; Strabelli, Tania Mara Varejao; Vieira, Marcelo Luiz Campos; De Medeiros Tranchesi, Regina Aparecida; Paiva, Marcelo Goulart; Fortes, Claudio Q.; De Oliveira Ramos, Auristela; Weksler, Clara; Ferraiuoli, Giovanna; Golebiovski, Wilma; Karlowsky, James A.; Keynan, Yoav; Morris, Andrew M.; Rubinstein, Ethan; Jones, Sandra Braun; Garcia, Patricia; Cereceda, M.; Fica, Alberto; Mella, Rodrigo Montagna; Fernandez, Ricardo; Franco, Liliana; Gonzalez, Javier; Jaramillo, Astrid Natalia; Bukovski, Suzana; Krajinovic, Vladimir; Pangercic, Ana; Rudez, Igor; Vincelj, Josip; Freiberger, Tomas; Pol, Jiri; Zaloudikova, Barbora; Ashour, Zainab; Kholy, Amani El; Mishaal, Marwa; Osama, Dina; Rizk, Hussien; Aissa, Neijla; Alauzet, Corentine; Alla, Francois; Campagnac, Catherine; Doco-Lecompte, Thanh; Selton-Suty, Christine; Casalta, Jean Paul; Fournier, Pierre Edouard; Habib, Gilbert; Raoult, Didier; Thuny, Franck; Delahaye, Francois.

In: Antimicrobial Agents and Chemotherapy, Vol. 59, No. 4, 01.04.2015, p. 2365-2373.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Candida infective endocarditis: An observational cohort study with a focus on therapy

AU - Arnold, Christopher J.

AU - Johnson, Melissa

AU - Bayer, Arnold S.

AU - Bradley, Suzanne

AU - Giannitsioti, Efthymia

AU - Miró, José M.

AU - Tornos, Pilar

AU - Tattevin, Pierre

AU - Strahilevitz, Jacob

AU - Spelman, Denis

AU - Athan, Eugene

AU - Nacinovich, Francisco

AU - Fortes, Claudio Q.

AU - Lamas, Cristiane

AU - Barsic, Bruno

AU - Fernández-Hidalgo, Nuria

AU - Muñoz, Patricia

AU - Chu, Vivian H.

AU - Clara, Liliana

AU - Sanchez, Marisa

AU - Casabé, José

AU - Cortes, Claudia

AU - Oses, Pablo Fernandez

AU - Ronderos, Ricardo

AU - Sucari, Adriana

AU - Thierer, Jorge

AU - Altclas, Javier

AU - Kogan, Silvia

AU - Harris, Owen

AU - Kennedy, Karina

AU - Tan, Ren

AU - Gordon, David

AU - Papanicolas, Lito

AU - Korman, Tony

AU - Kotsanas, Despina

AU - Dever, Robyn

AU - Jones, Phillip

AU - Konecny, Pam

AU - Lawrence, Richard

AU - Rees, David

AU - Ryan, Suzanne

AU - Feneley, Michael P.

AU - Harkness, John

AU - Post, Jeffrey

AU - Reinbott, Porl

AU - Gattringer, Rainer

AU - Wiesbauer, Franz

AU - Andrade, Adriana Ribas

AU - De Brito, Ana Cláudia Passos

AU - Guimarães, Armenio Costa

AU - Grinberg, Max

AU - Mansur, Alfredo José

AU - Siciliano, Rinaldo Focaccia

AU - Strabelli, Tania Mara Varejao

AU - Vieira, Marcelo Luiz Campos

AU - De Medeiros Tranchesi, Regina Aparecida

AU - Paiva, Marcelo Goulart

AU - Fortes, Claudio Q.

AU - De Oliveira Ramos, Auristela

AU - Weksler, Clara

AU - Ferraiuoli, Giovanna

AU - Golebiovski, Wilma

AU - Karlowsky, James A.

AU - Keynan, Yoav

AU - Morris, Andrew M.

AU - Rubinstein, Ethan

AU - Jones, Sandra Braun

AU - Garcia, Patricia

AU - Cereceda, M.

AU - Fica, Alberto

AU - Mella, Rodrigo Montagna

AU - Fernandez, Ricardo

AU - Franco, Liliana

AU - Gonzalez, Javier

AU - Jaramillo, Astrid Natalia

AU - Bukovski, Suzana

AU - Krajinovic, Vladimir

AU - Pangercic, Ana

AU - Rudez, Igor

AU - Vincelj, Josip

AU - Freiberger, Tomas

AU - Pol, Jiri

AU - Zaloudikova, Barbora

AU - Ashour, Zainab

AU - Kholy, Amani El

AU - Mishaal, Marwa

AU - Osama, Dina

AU - Rizk, Hussien

AU - Aissa, Neijla

AU - Alauzet, Corentine

AU - Alla, Francois

AU - Campagnac, Catherine

AU - Doco-Lecompte, Thanh

AU - Selton-Suty, Christine

AU - Casalta, Jean Paul

AU - Fournier, Pierre Edouard

AU - Habib, Gilbert

AU - Raoult, Didier

AU - Thuny, Franck

AU - Delahaye, Francois

PY - 2015/4/1

Y1 - 2015/4/1

N2 - Copyright © 2015, American Society for Microbiology. 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.

AB - Copyright © 2015, American Society for Microbiology. 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.

U2 - 10.1128/AAC.04867-14

DO - 10.1128/AAC.04867-14

M3 - Article

VL - 59

SP - 2365

EP - 2373

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 4

ER -

Candida infective endocarditis: An observational cohort study with a focus on therapy

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