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Candida spp. infective endocarditis: Characteristics and outcomes of twenty patients with a focus on injection drug use as a predisposing risk factor
Author(s) -
Morelli Morgan K.,
Veve Michael P.,
Lorson William,
Shorman Mahmoud A.
Publication year - 2021
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/myc.13200
Subject(s) - medicine , infective endocarditis , endocarditis , retrospective cohort study , risk factor , population , surgery , cohort , cardiac surgery , pediatrics , environmental health
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 and 2019 at a university hospital was analysed. Demographic data collected included IDU, microbiologic, treatment and mortality. The primary outcome of interest was 12‐month, all‐cause mortality. Results Twenty 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 hospitalisation. There were no in‐hospital fatalities, and 5 (25%) patients died at one year; all were IDU (39% to 0%, p = .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.