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Candida infective endocarditis

  • J. W. Baddley
  • D. K. BenjaminJr.
  • M. Patel
  • J. Miró
  • E. Athan
  • B. Barsic
  • E. Bouza
  • L. Clara
  • T. Elliott
  • Z. Kanafani
  • J. Klein
  • S. Lerakis
  • D. Levine
  • D. Spelman
  • E. Rubinstein
  • P. Tornos
  • A. J. Morris
  • P. Pappas
  • V. G. FowlerJr.
  • V. H. Chu
  • C. Cabell
  • The International Collaboration on Endocarditis—Prospective Cohort Study Group (ICE-PCS)
Article

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.

Keywords

Coronary Artery Bypass Grafting Fluconazole Endocarditis Voriconazole Infective Endocarditis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

Manuscript support

This study was sponsored in part by a grant from Merck and Co., Inc. The sponsor had no role in the design and the conduct of the study, or in the collection, analysis, and interpretation of the data.

Research support from NICHD K23HD-0044799 (DKB).

Potential conflicts of interest

JWB: Research support from Astellas and Merck, Inc. Speaker’s bureau for Merck and Enzon. Consulting services for Pfizer and Enzon.

DKB: Research support from Astellas, Pfizer, Inc., Biosynexus, Cape Cod Associates, Inc., Johnson & Johnson, and Astra Zeneca. Fellowship support from Johnson & Johnson and MedImmune. All monies go to Duke University. Dr. Benjamin does not own any stock or hold financial interest in any organization listed above.

MP: None.

JM: None.

EA: None.

BB: Grant support from the Croatian Ministry of Science, no. 108-1080002-0102. Consulting services for Pliva Pharmaceuticals. Speaker’s bureau for Pliva Pharmaceuticals, Pharmasuiss Zagreb. Unrestricted research grant from Roche d.o.o. Zagreb.

EB: None.

LC: None.

TE: None.

ZK: None.

JK: None.

SL: None.

DL: None.

DS: None.

ER: Research support from Theravance, Daiichi, Replidyne. Consulting services for Pfizer, Bayer, Wyeth, Teva, Replidyne, Schering Plough, Atox, and BiondVax.

PT: None.

AJM: None.

PP: None.

VGF: Research funding from Theravance, Merck, Nabi, Inhibitex, Cubist, and the National Institutes of Health. Consulting for Astellas, Biosynexus, Cubist, Inhibitex, Merck, Johnson & Johnson, and is on the speakers’ bureaus for Cubist and Pfizer.

VHC: None.

CC: None.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. W. Baddley
    • 1
    • 2
  • D. K. BenjaminJr.
    • 3
  • M. Patel
    • 1
    • 2
  • J. Miró
    • 4
  • E. Athan
    • 5
  • B. Barsic
    • 6
  • E. Bouza
    • 7
  • L. Clara
    • 8
  • T. Elliott
    • 9
  • Z. Kanafani
    • 10
  • J. Klein
    • 11
  • S. Lerakis
    • 12
  • D. Levine
    • 13
  • D. Spelman
    • 14
  • E. Rubinstein
    • 15
  • P. Tornos
    • 16
  • A. J. Morris
    • 17
  • P. Pappas
    • 18
  • V. G. FowlerJr.
    • 3
  • V. H. Chu
    • 3
  • C. Cabell
    • 3
  • The International Collaboration on Endocarditis—Prospective Cohort Study Group (ICE-PCS)
  1. 1.Department of Medicine, Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Medicine, Infectious Diseases SectionBirmingham Veterans Administration Medical CenterBirminghamUSA
  3. 3.Department of MedicineDuke University Medical CenterDurhamUSA
  4. 4.Department of Medicine, Infectious Disease Service, Institut d’Investigacions Biomediques August Pi i Sunyer-Hospital ClinicUniversity of BarcelonaBarcelonaSpain
  5. 5.Department of Infectious Diseases, Barwon HealthThe Geelong HospitalGeelongAustralia
  6. 6.Department of Infectious DiseasesUniversity Hospital for Infectious DiseasesZagrebCroatia
  7. 7.Department of Medical MicrobiologyHospital General Universitario Gregorio MarañónMadridSpain
  8. 8.Hospital ItalianoBuenos AiresArgentina
  9. 9.Department of Clinical Microbiology and Infection ControlQueen Elizabeth HospitalBirminghamUK
  10. 10.Department of MedicineAmerican University of Beirut Medical CenterBeirutLebanon
  11. 11.Department of MicrobiologySt. Thomas’ HospitalLondonUK
  12. 12.Department of MedicineEmory UniversityAtlantaUSA
  13. 13.Department of MedicineWayne State UniversityDetroitUSA
  14. 14.Department of MicrobiologyThe Alfred HospitalMelbourneAustralia
  15. 15.Department of Medicine, Section of Infectious DiseasesUniversity of ManitobaWinnipegCanada
  16. 16.Department of CardiologyHospital Universitari Vall d’HebronBarcelonaSpain
  17. 17.Department of MicrobiologyAuckland City HospitalGraftonNew Zealand
  18. 18.Outcomes Research and Assessment GroupDuke Clinical Research InstituteDurhamUSA

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