Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study. (25th October 2017)

• Record Type: Journal Article
• Authors: Rivoisy, Claire; Vena, Antonio; Schaeffer, Laura; Charlier, Caroline; Fontanet, Arnaud; Delahaye, François; Bouza, Emilio; Lortholary, Olivier; Munoz, Patricia; Lefort, Agnès
• Is Part Of: Clinical infectious diseases. Volume 66:Number 6(2018)
• Page Start: 825
• Page End: 832
• Publication Date: 2017-10-25
• Subjects: Candida -- endocarditis -- prosthetic valve; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/cix913
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : Prosthetic valve Candida spp. endocarditis is rare but remains severe, with a 6-month mortality rate of 34%. Liposomal amphotericin B–based "induction" treatment followed by "maintenance" fluconazole may improve the outcome. Surgery is not mandatory for frail patients. Abstract: Background: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)–based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59–29.13] and 10.92 [1.15–104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03–838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2–84 months), led to minor adverse effects. Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.