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Candida Infective Endocarditis: Report of 15 Cases From a Prospective Multicenter Study

Falcone, Marco MD; Barzaghi, Nicoletta MD; Carosi, Giampiero MD; Grossi, Paolo MD; Minoli, Lorenzo MD; Ravasio, Veronica MD; Rizzi, Marco MD; Suter, Fredy MD; Utili, Riccardo MD; Viscoli, Claudio MD; Venditti, Mario MD

doi: 10.1097/MD.0b013e3181a693f8

Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy of Candida IE are poorly defined. We conducted a prospective, observational study at 18 medical centers in Italy, including all consecutive patients with a definite diagnosis of IE admitted from January 2004 through December 2007.

A Candida species was the causative organism in 8 cases of prosthetic valve endocarditis (PVE), 5 cases of native valve endocarditis (NVE), 1 case of pacemaker endocarditis, and 1 case of left ventricular patch infection. Candida species accounted for 1.8% of total cases, and for 3.4% of PVE cases. Most patients (86.6%) had a health care-associated infection. PVE associated with a health care contact occurred after a median of 225 days from valve implantation. Ten patients (66.6%) were treated with caspofungin alone or in combination with other antifungal drugs. The overall mortality rate was 46.6%. Mortality was higher in patients with PVE (5 of 8 cases, 62.5%) than in patients with NVE (2 of 5 patients, 40%). A better outcome was observed in patients treated with a combined medical and surgical therapy.

Candida IE should be classified as an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial related morbidity and mortality. Candida PVE usually is a late-onset disease, which becomes clinically evident even several months after an initial episode of transient candidemia.

Abbreviations: CVC = central venous catheter, ICU = intensive care unit, IE = infective endocarditis, IV = intravenous, NVE = native valve endocarditis, PVE = prosthetic valve endocarditis, SEI = Italian Study on Endocarditis.

From Dipartimento di Medicina Clinica (MF, MV), Policlinico Umberto I, Università degli Studi di Roma "La Sapienza," Rome; UO Terapia Intensiva Cardiochirurgica (NB), ASO S. Croce e Carle, Cuneo; Malattie Infettive e Tropicali (GC), Università degli Studi di Brescia, Brescia; Malattie Infettive e Tropicali (PG), Università degli Studi dell'Insubria, Varese; Malattie Infettive (LM), IRCCS San Matteo, Pavia; Malattie Infettive (VR, MR, FS), Ospedali Riuniti di Bergamo, Bergamo; Medicina Infettivologica e dei Trapianti (RU), Azienda Ospedaliera Monaldi, Napoli; Clinica Malattie Infettive (CV), Università di Genova, Genova, Italy.

*See Appendix for list of SEI investigators.

Received September 20, 2008, and in revised form January 7, 2009.

Accepted for publication March 3, 2009.

Reprints: Mario Venditti, MD, Dipartimento di Medicina Clinica, Policlinico Umberto I. University of Rome "La Sapienza," Viale dell'Università 37, 00185 Rome, Italy; (e-mail:

© 2009 by Lippincott Williams & Wilkins, Inc.