Candida Infective Endocarditis in Patients With Candida spp. Bloodstream Infection: Risk Factors and 1- Year Mortality.

Abstract

Introduction: Although there are some studies evaluating CIE incidence and associated risk factors, none assessed mortality several months after the Candida spp. BSI episode. We aimed to assess risk factors for CIE and outcomes, including 1-year mortality, in patients with Candida spp. BSI in a public tertiary-care teaching hospital in Brazil.

Patients and methods: Retrospective case-control, followed by a cohort study, with adult patients who presented a Candida spp. BSI. Participants were eligible if they had at least one echocardiogram performed no longer than 3 days before Candida spp. BSI diagnosis and thereafter during the respective hospital admission. CIE diagnosis was defined by the presence of two major Duke criteria.

Results: We studied 164 patients (median age: 57.6 years) with a median Charlson comorbidity index of 3 points. Most patients were female (54.9%), were on haemodialysis (54.9%), and 4.6% had a preexisting moderate/severe heart valve disease. C. albicans (36.2%) and C. parapsilosis complex (34.4%) were the most frequent Candida species identified. CIE was detected in 10 patients (6.1%; 95% CI: 2.4%-9.8%). In the multivariable analysis, age and C. parapsilosis complex remained as independent predictors of CIE. There was no significant difference between CIE and no CIE groups in 1-year mortality after Candida spp. BSI diagnosis and hospital discharge.

Discussion: Considering the low costs and hazards associated with an echocardiogram, performing it systematically in all patients with Candida spp. BSI might improve CIE diagnosis and ultimately survival rates.