Claire Rivoisy1, Antonio Vena2,3,4,5, Laura Schaeffer6, Caroline Charlier1, Arnaud Fontanet6,7, François Delahaye8, Emilio Bouza4,5,9, Olivier Lortholary1,10, Patricia Munoz2,3,4,5, Agnès Lefort11,12. 1. Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France. 2. Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain. 3. Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain. 4. CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain. 5. Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain. 6. Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France. 7. PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France. 8. Hospices Civils de Lyon, Université Claude Bernard Lyon 1, France. 9. Hospital General Universitario Gregorio Marañón, Madrid Spain. 10. Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Clichy, France. 11. IAME, UMR1137, Université Paris-Diderot, Sorbonne Paris Cité, Clichy, France. 12. Service de Médecine Interne, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val-de-Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France.
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.
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.
Authors: Adrián Jerónimo; Carmen Olmos; Isidre Vilacosta; Carmen Sáez; Javier López; Marta Sanz; Gonzalo Cabezón; Javier B Pérez-Serrano; Pablo Zulet; J Alberto San Román Journal: Eur J Clin Microbiol Infect Dis Date: 2022-05-14 Impact factor: 3.267
Authors: Petros Ioannou; Maria Volosyraki; Vasiliki Mavrikaki; Ioanna Papakitsou; Anna Mathioudaki; George Samonis; Diamantis P Kofteridis Journal: Germs Date: 2020-09-01