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 (1, 2) , Jacob Strahilevitz , Denis Spelman , Eugene Athan , Francisco Nacinovich , Claudio Q. Fortes , Cristiane Lamas , Bruno Barsic , Nuria Fernández-Hidalgo , Patricia Muñoz (3) , Vivian H. Chu

1 Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes]
2 Fonction, structure et inactivation d'ARN bactériens
3 Clinical Microbiology and Infectious Diseases Department

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.

Domaines: Microbiologie et Parasitologie

Christopher J. Arnold, Melissa Johnson, Arnold S. Bayer, Suzanne Bradley, Efthymia Giannitsioti, et al.. Candida infective endocarditis: an observational cohort study with a focus on therapy. Antimicrobial Agents and Chemotherapy, 2015, 59 (4), pp.2365--2373. ⟨10.1128/AAC.04867-14⟩. ⟨hal-01147271⟩