Risk factors predicting Candida infective endocarditis in patients with candidemia

Abstract

<jats:title>Abstract</jats:title> <jats:p>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.</jats:p>

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

“…Two (10%) additional cases involved infected CIED wires. An analysis of the risk of CIE in patients with candidaemia identified valvular heart disease as the most common exposure, with a sevenfold increased risk of CIE when these patients have candidaemia 22 . This was similar to our cohort with 10 (77%) of the IDU patients having history of previous IE.…”

Candida Infective Endocarditis: A Retrospective Study of Patient Characteristics and Risk Factors for Death in 703 United States Cases, 2015–2019

“…A recent retrospective cohort study evaluating risk factors for CIE among patients with candidemia showed a similar pattern. Although valvular heart disease was associated with a higher odds of CIE (OR, 7.66; 95% CI, 3.0–19.8), both hematologic malignancy and receipt of TPN were associated with a lower odds of CIE [ 8 ].…”

(1,3)‐β‐D‐glucan is able to predict therapeutic failure of patients with candidemia and not only mortality

“…A baseline assessment of the risk of having therapeutic failure may help clinicians to advance difference strategies depending on the baseline BDG value. The routine screening of deep‐seated infections in candidemia that is mentioned in most guidelines, such as dilated fundoscopy to diagnose endophthalmitis and echocardiography to diagnose endocarditis, increases hospitalisation costs and has been argued by some authors, due to the low prevalence of such complications in most series 32,33 . In this perspective, we explored the possibility of using baseline BDG as a reference for selecting patients where imaging and eye examination for screening deep‐seated infections should be performed.…”