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Diagnostic, management and outcome of Candida endocarditis

A Lefort, L Chartier, B Sendid, M Wolff... - Clinical ..., 2012 - Wiley Online Library This is an Accepted Article that has been peer-reviewed and approved for publication in the Clinical Microbiology and Infection, but has yet to undergo copy-editing and proof correction. Please cite this article as an Accepted Article; doi: 10.1111/j.1469- 0691.2012.03764.x [CITATION] 190 Surgery of infective endocarditis analyzed within a one-year population-based study F Delahaye, C Suty-Selton, B Iung... - Archives of ..., 2012 - Elsevier France

Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of CE remains difficult, non culture based tools need to be evaluated. Through the French prospective MYCENDO study (2005 2007), the overall characteristics and risk factors for death from CE were analysed. The contribution of antigen detection (mannan/anti mannan antibodies and (1,3) d glucans) and molecular tools was evaluated. Among 30 CE cases, 19 were caused by non albicans species. Sixteen patients (53%) had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were intravenous drug users; none of them had right sided CE. Among the 21 patients who were not intravenous drug users, 18 (86%) had healthcare associated CE. Initial therapy consisted of a combination of antifungals in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow up was 1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On univariate analysis, patients aged ≥60 years had a higher mortality risk (OR 11, 95% CI 1.2 103.9; p 0.024), whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02 0.7; p 0.03). Among 18 patients screened for both serum mannan/anti mannan antibodies and (1,3) d glucans, all had a positive result with at least one of either test at CE diagnosis. Real time PCR was performed on blood (Septi Fast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens and molecular tools may contribute to earlier CE diagnosis.