965. Candida Endocarditis at a Large Tertiary Center
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Infectious Endocarditis (IE) caused by candida species is increasing in incidence in recent years. Much of the data is derived from large case series including patients from multiple centers with a lack of follow up data. We present the largest case series to date from a single center with an active cardiac surgery service.

Methods: Cases were ascertained using the Cardiovascular Information Registry and Diagnosis Related Group database searching for patients with a diagnosis of fungal or candidal infections and cross-matching with those diagnosed with endocarditis from 9/1996-3/2011. Case definition included those who met search criteria and were confirmed to have definite IE based on modified Duke’s criteria with candida species being the etiologic agent.

Results: Thirty-five patients met case definition. Sixteen (46%) had a central venous catheter, 24 (69%) had a prosthetic valve, 8 (23%) had a pacemaker or defibrillator, 12 (34%) had a history of IE and 8 (23%) were IV drug abusers. Blood cultures were positive in 31 (89%), valve cultures in 83% and fungal smear in 63% of valves examined. Echocardiogram suggested IE in 22 (63%) and 29 (83%) patients on surface and transesophageal respectively. C. albicans was seen in 18 (51%) and C. parapsilosis in 11 (31%). Additional species included C. lusitaniae, C. tropicalis, C. dublinensis and C. krusei. Heart failure from IE occurred in 13 (37%), embolism in 18 (51%) and myocardial abscess in 13 (37%). Ten patients (29%) died prior to discharge and 13 (37%) within 6 months. Twenty-seven patients (77%) were treated surgically. There was no significant difference in in-hospital mortality or all-cause mortality at 6 months between surgically and non-surgically treated patients. Echinocandins were the predominant therapy in 8 (23%). There was no significant difference between those treated with echinocandins in in-hospital mortality or all-cause mortality at 6 months.

Conclusion: Our data is consistent with prior reports of candida IE in regards to complications and outcomes. Echinocandin use is becoming an acceptable treatment alternative with similar outcomes compared to those without echinocandin use. Likewise, mortality data was similar between surgical and non-surgically treated patients.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Christopher S. Ledtke, MD1, Nabin K. Shrestha, MD, MPH1, Thomas G. Fraser, MD2, Steven Gordon, MD, FIDSA2 and David van Duin, MD, PhD3, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Cleveland Clinic Foundation, Cleveland, OH, (3)Infectious Disease, Cleveland Clinic Foundation, Cleveland, OH

Disclosures:

C. S. Ledtke, None

N. K. Shrestha, Astellas: Consultant, Consulting fee
Cubist: Grant Investigator, Grant recipient
Forest: Speaker's Bureau, Speaker honorarium

T. G. Fraser, None

S. Gordon, None

D. van Duin, Pfizer: Consultant, Consulting fee
Astellas: Speaker's Bureau, Speaker honorarium

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