TY - JOUR
T1 - Risk factors predicting Candida infective endocarditis in patients with candidemia
AU - Foong, Kap Sum
AU - Sung, Abby
AU - Burnham, Jason P.
AU - Kronen, Ryan
AU - Lian, Qinghua
AU - Salazar Zetina, Ana
AU - Hsueh, Kevin
AU - Lin, Charlotte
AU - Powderly, William G.
AU - Spec, Andrej
N1 - Funding Information:
This study was funded by Astellas Pharma Global Development, Inc., through an investigator-sponsored grant (MYCA-15L03). In addition, research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). Astellas Pharma Global Development, Inc., was not involved in study design, implementation, data analysis, manuscript drafting, or the final approval for publication. This work was the sole responsibility of the authors. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH or Astellas Pharma Global Development, Inc.
Publisher Copyright:
© 2019 The Author(s). Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.
PY - 2019/11/23
Y1 - 2019/11/23
N2 - Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95-19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04-0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01-0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16-0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P =. 338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source.
AB - Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95-19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04-0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01-0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16-0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P =. 338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source.
KW - Candida bloodstream infection
KW - Candida infective endocarditis
KW - candidemia
UR - http://www.scopus.com/inward/record.url?scp=85087466981&partnerID=8YFLogxK
U2 - 10.1093/mmy/myz104
DO - 10.1093/mmy/myz104
M3 - Article
C2 - 31613365
AN - SCOPUS:85087466981
SN - 1369-3786
VL - 58
SP - 593
EP - 599
JO - Medical Mycology
JF - Medical Mycology
IS - 5
ER -