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Candida Infective Endocarditis in Patients With Candida spp. Bloodstream Infection: Risk Factors and 1- Year
Tarsila Vieceli1, Betina Maria Giordani1,2, Gabriel Azeredo de Magalhães2
1Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
Insights
This study found that age and Candida parapsilosis complex are predictors of infective endocarditis (IE) in patients with Candida bloodstream infections (BSI). Echocardiograms may improve IE diagnosis and survival rates.
Area of Science:
- Infectious Diseases
- Cardiology
- Critical Care Medicine
Background:
- Candida spp. bloodstream infections (BSI) can lead to infective endocarditis (IE), a serious complication.
- Limited data exists on risk factors for IE and mortality following Candida spp. BSI, especially in resource-limited settings.
Purpose of the Study:
- To assess risk factors for IE and evaluate outcomes, including 1-year mortality, in patients with Candida spp. BSI.
- To identify predictors of IE in this patient population.
Main Methods:
- Retrospective case-control and cohort study involving adult patients with Candida spp. BSI.
- Inclusion criteria required echocardiograms within 3 days before diagnosis and during hospitalization.
- IE diagnosis followed the modified Duke criteria.
Main Results:
- 164 patients were studied; 6.1% were diagnosed with IE.
- Independent predictors for IE were older age and infection with Candida parapsilosis complex.
- No significant difference in 1-year mortality was observed between patients with and without IE.
Conclusions:
- Systematic echocardiography in all patients with Candida spp. BSI may enhance IE diagnosis.
- Early diagnosis through echocardiography could potentially improve patient survival rates.
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.
