Fungal endocarditis: patients at risk and their treatment

Comparison of fluconazole and amphotericin B for prevention and treatment of experimental Candida endocarditis

“…Furthermore, there was a trend toward an increased number of culture-negative vegetations in the fluconazole group after 14 or 21 days of therapy compared with untreated controls, although this trend did not achieve statistical significance (data not shown). DISCUSSION The placement of prosthetic cardiac material, including valves, patch grafts, ventricular-assist devices, and artificial hearts, may be complicated by the development of deviceassociated fungal endocarditis (13,15,18). Such infections are invariably refractory to medical therapy alone and require surgical intervention for definitive cure (2,15).…”

“…DISCUSSION The placement of prosthetic cardiac material, including valves, patch grafts, ventricular-assist devices, and artificial hearts, may be complicated by the development of deviceassociated fungal endocarditis (13,15,18). Such infections are invariably refractory to medical therapy alone and require surgical intervention for definitive cure (2,15). The role of antifungal prophylaxis in the surgical placement of such prosthetic devices has been neglected because of significant problems associated with previously available drugs, including systemic and end-organ toxicity (amphotericin B), rapid selection of drug resistance (flucytosine), and lack of parenteral preparations (ketoconazole); similar problems have limited the use of antifungal treatment alone for established fungal prosthetic-device infections.…”

“…drug abuse or in patients undergoing long-term i.v. therapy with antibiotics or hyperalimention (7,10,13,15,18). Even with early diagnosis, Candida endocarditis is difficult to eradicate with antifungal therapy alone, and valve replacement remains a requirement for cure in most patients (2,15).…”

“…therapy with antibiotics or hyperalimention (7,10,13,15,18). Even with early diagnosis, Candida endocarditis is difficult to eradicate with antifungal therapy alone, and valve replacement remains a requirement for cure in most patients (2,15). While amphotericin B and flucytosine are synergistic in vitro against many strains of Candida and the combination has been successful in some patients without concomitant valve replacement (13), these agents are associated with significant nephrotoxicity and bone marrow suppression when used in combination (6,19).…”

Comparison of fluconazole and amphotericin B for treatment of experimental Candida endocarditis caused by non-C. albicans strains

“…Endovascular infections caused by Candida species, including endocarditis, prosthetic graft infections, and septic thrombophlebitis, are being increasingly recognized (4,11,13,14,17). This increase relates to the common use of indwelling intravascular catheters for antibiotic, chemotherapy, or hyperalimentation administrations, as well as prosthetic valve and graft placements for cardiovascular indications, highlighting the propensity of Candida strains to adhere to such prosthetic materials (10).…”