Candida spp. Infective Endocarditis: Characteristics and Outcomes of Twenty Patients with a Focus on Injection Drug use as a Predisposing Risk Factor

Morgan K Morelli, Michael P Veve, William Lorson, Mahmoud A Shorman
Mycoses 2020 October 18

BACKGROUND: Candida spp. infective endocarditis (CIE) although rare is associated with high morbidity and mortality. Risk factors include prosthetic heart valves and injection drug use (IDU). We reviewed all cases of CIE at our institution to describe the microbiology, treatment, and outcomes of patients focusing on IDU as a predisposing factor.

METHODS: Retrospective cohort of patients with definite CIE between 2013-2019 at a university hospital was analyzed. Demographic data collected included IDU, microbiologic, treatment, and mortality. The primary outcome of interest was 12-month, all-cause mortality.

RESULTS: 20 patients were included (one had two separate episodes of CIE); CIE accounted for 4% of total infective endocarditis (IE) cases during the study period. The median (IQR) age was 38 (30-58) years, 10 (50%) had a previous history of IE, and 4 (20%) patients had prosthetic heart valves or an implanted cardiac device. Thirteen (65%) patients were IDU. The tricuspid valve was the primary valve involved (8/18, 44%), and C. albicans was the most frequently isolated organism (8, 36%). Echinocandin was the most common treatment strategy (8, 40%). Only three (15%) patients underwent valve replacement during hospitalization. There were no in-hospital fatalities, and 5 (25%) patients died at one-year; all were IDU (39% to 0%, P=0.11).

CONCLUSION: CIE is a rare infectious disease seen more commonly in the IDU population. Cardiac surgery was rarely performed, and long-term mortality was 25%. Additional data are needed to identify ideal management strategies in this population.

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