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.