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 and Chu, Vivian H. 2015, Candida infective endocarditis: an observational cohort study with a focus on therapy, Antimicrobial agents and chemotherapy, vol. 59, no. 4, pp. 2365-2373, doi: 10.1128/AAC.04867-14.

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Title Candida infective endocarditis: an observational cohort study with a focus on therapy
Formatted title Candida infective endocarditis: an observational cohort study with a focus on therapy
Author(s) Arnold, Christopher J.
Johnson, Melissa
Bayer, Arnold S.
Bradley, Suzanne
Giannitsioti, Efthymia
Miró, José M.
Tornos, Pilar
Tattevin, Pierre
Strahilevitz, Jacob
Spelman, Denis
Athan, EugeneORCID iD for Athan, Eugene
Nacinovich, Francisco
Fortes, Claudio Q.
Lamas, Cristiane
Barsic, Bruno
Fernández-Hidalgo, Nuria
Muñoz, Patricia
Chu, Vivian H.
Journal name Antimicrobial agents and chemotherapy
Volume number 59
Issue number 4
Start page 2365
End page 2373
Total pages 9
Publisher American Society for Microbiology
Place of publication Washington, D.C.
Publication date 2015-04
ISSN 0066-4804
Summary 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.
Notes Prepared for the ICE Investigators Group.
Language eng
DOI 10.1128/AAC.04867-14
Field of Research 111799 Public Health and Health Services not elsewhere classified
0605 Microbiology
1108 Medical Microbiology
1115 Pharmacology And Pharmaceutical Sciences
Socio Economic Objective 920499 Public Health (excl. Specific Population Health) not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2015, American Society for Microbiology
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Document type: Journal Article
Collection: School of Medicine
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