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The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort

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Abstract

Most current guidelines do not recommend systematic screening with echocardiography in patients with candidemia, as Candida infective endocarditis (CIE) is considered an uncommon disease. During the study period, we recommended echocardiography systematically to all candidemic patients that did not have contraindications and accepted to participate in the study. We intended to assess the incidence of unrecognized CIE in adult patients with candidemia. Our institution is a tertiary teaching hospital in which we follow all patients with candidemia. From January 2007 to October 2012, echocardiography was systematically recommended to suitable candidates. We recorded 263 cases of candidemia in adult patients. Echocardiography was not performed in 76 of these patients for the following reasons: patients had died when blood cultures became positive (17), patients were critically or terminally ill (38), or the patient or physician refused the procedure (21). The remaining 187 patients constitute the basis of this report. CIE was diagnosed in 11 cases (4.2 % of the whole candidemic population and 5.9 % of the population with echocardiographic study). The results of transthoracic echocardiography (TTE) suggested infective endocarditis (IE) in 5/172 patients (2.9 %), and the result of transesophageal echocardiography (TEE) was positive in 10/87 (11.5 %). Among 11 confirmed cases of CIE, the disease was clinically unsuspected in three patients. At least 4.2 % of all candidemic patients have CIE. CIE is frequently clinically unsuspected and echocardiography is required to demonstrate a high proportion of cases.

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Abbreviations

CIE:

Candida infective endocarditis

IE:

Infective endocarditis

TTE:

Transthoracic echocardiography

TEE:

Transesophageal echocardiography

GAME:

Grupo de Apoyo al Manejo de la Endocarditis

SAB:

Staphylococcus aureus bacteremia

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Acknowledgments

We thank the members of the GAME study group (Grupo de Apoyo al Manejo de la Endocarditis) for their contribution to the work:

Javier Bermejo, Emilio Bouza, Alia Eworo, Ana Fernández Cruz, Marcela González del Vecchio, Víctor González Ramallo, Martha Kestler Hernández, Mercedes Marín, Manuel Martínez-Sellés, Mª Cruz Menárguez, Patricia Muñoz, Hugo Rodríguez-Abella, Marta Rodríguez-Créixems, Jorge Rodríguez Roda, Marisol Salas, Antonio Segado, Blanca Pinilla, Ángel Pinto, Maricela Valerio, Eduardo Verde.

We are grateful to Thomas O’Boyle for the editorial assistance.

Ana Fernández-Cruz had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Ethical statement

This paper complies with the recommended ethical standards and was reviewed and approved by the Ethics Committee of the Hospital Universitario Gregorio Marañón. Informed consent was obtained from all individual participants included in the study. It has not been previously published, nor is it being considered for publication elsewhere. All financial and material support for this research and work is clearly identified in the manuscript. None of the authors has any conflicts of interest to declare.

Funding

This work was supported by Instituto de Salud Carlos III, PROMULGA Project (grant number PI1002868).

Contribution of authors

Ana Fernández-Cruz wrote the article and contributed to the design of the study, care of the patients, and collection of the data. Patricia Muñoz and Emilio Bouza contributed to the design of the study and care of the patients. Miguel Pedromingo contributed to the collection of the data. María Cruz Menárguez contributed to the collection of the data, maintenance of the database, and was the link with the echocardiography laboratory. Jorge Solís performed the echocardiography studies. Teresa Peláez and Marta Rodríguez-Créixems performed the laboratory work with fungal blood cultures. All the authors reviewed the manuscript.

Conflict of interest

The authors declare no conflicts of interest involving this work.

Author information

Authors and Affiliations

  1. Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    A. Fernández-Cruz, M. Cruz Menárguez, P. Muñoz, M. Pedromingo, T. Peláez, M. Rodríguez-Créixems & E. Bouza

  2. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain

    J. Solís

  3. School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain

    P. Muñoz, T. Peláez, M. Rodríguez-Créixems & E. Bouza

  4. CIBER de Enfermedades Respiratorias (CIBERES CD06/06/0058), Palma de Mallorca, Spain

    P. Muñoz, T. Peláez, M. Rodríguez-Créixems & E. Bouza

  5. PROMULGA Project, Instituto de Salud Carlos III, PI1002868, Madrid, Spain

    P. Muñoz, T. Peláez, M. Rodríguez-Créixems & E. Bouza

  6. Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, 28007, Madrid, Spain

    A. Fernández-Cruz

  7. Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, 28007, Madrid, Spain

    E. Bouza

Authors
  1. A. Fernández-Cruz
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  2. M. Cruz Menárguez
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  3. P. Muñoz
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  4. M. Pedromingo
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  5. T. Peláez
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  6. J. Solís
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  7. M. Rodríguez-Créixems
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  8. E. Bouza
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Consortia

on behalf of the GAME Study Group (Grupo de Apoyo al Manejo de la Endocarditis)

Corresponding author

Correspondence to A. Fernández-Cruz.

Electronic Supplementary Material

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Online Resource 1

Study flow-chart (DOCX 54.7 kb)

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Fernández-Cruz, A., Cruz Menárguez, M., Muñoz, P. et al. The search for endocarditis in patients with candidemia: a systematic recommendation for echocardiography? A prospective cohort. Eur J Clin Microbiol Infect Dis 34, 1543–1549 (2015). https://doi.org/10.1007/s10096-015-2384-z

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  • DOI: https://doi.org/10.1007/s10096-015-2384-z

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