Candida Infective Endocarditis: an Observational Cohort Study with a Focus on Therapy
Candida Infective Endocarditis: an Observational Cohort Study with a Focus on Therapy
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DOI：
10.1128/aac.04867-14
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发表时间：
2015-04-01
影响因子：
4.9
通讯作者：
Chu, Vivian H.
中科院分区：
文献类型：
--
作者：
Arnold, Christopher J.;Johnson, Melissa;Chu, Vivian H.
念珠菌感染性心内膜炎是一种罕见的疾病，死亡率高。我们对这种感染的了解来自病例系列、病例报告和小型前瞻性队列。本研究的目的是评价念珠菌感染性心内膜炎的临床特点和不同抗真菌治疗方案的使用。这项前瞻性队列研究基于国际心内膜炎合作组织(ICE)-前瞻性队列研究和ICE- plus数据库收集的2000年至2010年间的70例念珠菌感染性心内膜炎。大多数感染是院内获得性的（67%）。充血性心力衰竭（24%）、人工心脏瓣膜（46%）和既往感染性心内膜炎（26%）是常见的合并症。总体死亡率很高，住院死亡率为36%，1年死亡率为59%。单因素分析显示，年龄较大、基线心力衰竭、持续性念珠菌感染、院内获得性、心衰并发症和心内脓肿与较高的死亡率相关。死亡率不受手术治疗或抗真菌药物选择的影响。对33例可获得特异性抗真菌治疗信息的患者进行亚组分析。在该亚组中，11例患者接受两性霉素b为基础的治疗，14例接受棘白菌素为基础的治疗。尽管棘白菌素组老年患者和医院感染的比例较高，但两组之间的死亡率相似。总之，念珠菌感染性心内膜炎与高死亡率相关，不受选择抗真菌治疗或辅助手术干预的影响。此外，在小亚组分析中，棘白菌素治疗与两性霉素b治疗同样有效。
Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.