Candida spp. infective endocarditis: Characteristics and outcomes of twenty patients with a focus on injection drug use as a predisposing risk factor

Abstract

BackgroundCandida spp. infective endocarditis (CIE) although rare is associated with high morbidity and mortality. Risk factors include prosthetic heart valves and injection drug use (IDU). We reviewed all cases of CIE at our institution to describe the microbiology, treatment and outcomes of patients focusing on IDU as a predisposing factor.MethodsRetrospective cohort of patients with definite CIE between 2013 and 2019 at a university hospital was analysed. Demographic data collected included IDU, microbiologic, treatment and mortality. The primary outcome of interest was 12‐month, all‐cause mortality.ResultsTwenty patients were included (one had two separate episodes of CIE); CIE accounted for 4% of total infective endocarditis (IE) cases during the study period. The median (IQR) age was 38 (30‐58) years, 10 (50%) had a previous history of IE, and 4 (20%) patients had prosthetic heart valves or an implanted cardiac device. Thirteen (65%) patients were IDU. The tricuspid valve was the primary valve involved (8/18, 44%), and C albicans was the most frequently isolated organism (8, 36%). Echinocandin was the most common treatment strategy (8, 40%). Only three (15%) patients underwent valve replacement during hospitalisation. There were no in‐hospital fatalities, and 5 (25%) patients died at one year; all were IDU (39% to 0%, p = .11).ConclusionCIE is a rare infectious disease seen more commonly in the IDU population. Cardiac surgery was rarely performed, and long‐term mortality was 25%. Additional data are needed to identify ideal management strategies in this population.

Clinical and Epidemiological Characteristics of Persistent Bacteremia: A Decadal Observational Study

“…is the causative pathogen of infection in patients with immunosuppressive conditions associated with chemotherapy or organ transplantation for malignant cancers and showed that the proportion of patients with solid or blood cancers and immunosuppressive status is higher among patients with Candida PB than among those with GPC PB and GNR PB [ 52 ]. In candidemia, the fungus spreads homogeneously, which can cause conditions such as IE [ 59 ], purulent spondylitis, and purulent arthritis [ 60 ]. Patients with candidemia are often in poor general condition because of immunosuppression or other reasons, so active source control such as debridement is often difficult.…”

Injection Drug Use-Associated Infective Endocarditis

“…IE due to candida species is relatively rare, accounting for around 2-4% of all cases [93,94]. Multiple outbreaks of disseminated candida infections have been traced back to using lemon juice as a solvent for intravenous heroin and cocaine [95][96][97].…”

Questioning the 14‐day dogma in candidemia treatment duration

“…39 This is also endorsed by current guidelines, which only support a discontinuation of antifungal treatment if neutropenia has resolved. 17,18 Furthermore, in case of uncertain duration of ongoing candidemia, which is, for example typically the case in patients with intravenous drug use, the relative risk for occult metastatic infection sites or deep-seated tissue candidiasis 40,41 is elevated. Moreoever, it is also recommended to avoid treatment reducing in patients with suppurative thrombophlebitis, pacemakers, intraventricular devices and endovascular prostheses.…”