Contemporary comparison of infective endocarditis caused by Candida albicans and Candida parapsilosis: a cohort study

Area of Science:

• Infectious Diseases
• Mycology
• Cardiology

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining.
• Candida species are increasingly recognized as a cause of IE, particularly in specific patient populations.
• Candida albicans IE (CAIE) and Candida parapsilosis IE (CPIE) represent distinct clinical entities.

Purpose of the Study:

• To compare the clinical characteristics, management, and outcomes of IE caused by Candida albicans versus Candida parapsilosis.
• To identify specific risk factors and differences in presentation between CAIE and CPIE.

Main Methods:

• Retrospective analysis of 1655 IE patients treated between 1998 and 2020.
• Inclusion of 16 patients with IE caused by Candida albicans (n=8) and Candida parapsilosis (n=8).
• Comparison of epidemiological data, clinical presentation, microbiological findings, treatment strategies, and in-hospital mortality.

Main Results:

• CPIE cases were more frequently community-acquired compared to CAIE.
• Prosthetic valve involvement was significantly more common in CPIE.
• CPIE patients showed higher rates of positive blood and valve cultures, and persistently positive blood cultures despite antifungal treatment.
• Urgent cardiac surgery was more common in CPIE, though in-hospital mortality did not differ between the two groups.

Conclusions:

• Candida parapsilosis infective endocarditis presents distinct epidemiological and clinical features compared to Candida albicans.
• Despite more aggressive disease manifestations and higher rates of urgent surgery in CPIE, in-hospital mortality remains comparable.
• These findings highlight the importance of species-specific considerations in the management of Candida IE.