Open AccessRisk factors predicting Candida infective endocarditis in patients with candidemia
Author(s) -
Kap Sum Foong,
Abby Sung,
Jason P. Burnham,
Ryan Kronen,
Qinghua Lian,
Ana S. Salazar,
Kevin Hsueh,
Chih-Lung Lin,
William G. Powderly,
Andrej Spec
Publication year - 2019
Publication title -
medical mycology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.004
H-Index - 86
eISSN - 1460-2709
pISSN - 1369-3786
DOI - 10.1093/mmy/myz104
Subject(s) - medicine , odds ratio , confidence interval , fungemia , infective endocarditis , retrospective cohort study , candida glabrata , incidence (geometry) , logistic regression , endocarditis , surgery , mycosis , antifungal , physics , dermatology , optics
Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95-19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04-0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01-0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16-0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P = .338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source.