Program Schedule

929
Comparison of Echinocandin vs. Amphotericin B Based Therapy for Candida Infective Endocarditis: An Observational Cohort Study

Session: Poster Abstract Session: Infective Endocarditits: Epidemiology, Diagnosis, and Management
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • Candida IE poster pdf.pdf (288.8 kB)
  • Background: The optimal therapy for Candida infective endocarditis (IE) is unknown, and treatment guidelines are based largely on single site case series and case reports. The current guidelines have added echinocandins as a treatment option.  We sought to compare amphotericin B based therapy to echinocandin based therapy, using two large, prospective, international, multi-center cohorts of patients with definite IE.  

    Methods: We identified cases of definite Candida IE presenting between June 1, 2000 and September 30, 2011 from the International Collaboration on Endocarditis – Prospective Cohort Study (ICE-PCS) and the International Collaboration on Endocarditis Plus (ICE-Plus).  A supplemental case report form was sent to enrolling sites to gather detailed information on antifungal therapy.  We compared clinical characteristics and outcomes  based on antifungal regimen received. 

    Results: 72 cases of definite Candida IE were identified of which 33 had supplemental data on antifungal therapy available.  The most common infecting species were C. albicans (n=13) and C. parapsilosis (n=12).  Most patients received either an amphotericin B based regimen (33%) or an echinocandin based regimen (42%). Nearly half received combination antifungal therapy (45%) and surgical therapy was used in 13 patients (39%).  There was no difference in either 42 day or 1 year mortality between those receiving an amphotericin B based regimen vs. those receiving an echinocandin based regimen (36% vs. 36% and 64% vs. 69%, respectively, p=1).  

    Conclusion: This is one of the largest prospective series of Candida endocarditis patients to date.  In this cohort, there was no difference in mortality with echinocandin based therapy as compared to amphotericin B based therapy.  This study is limited by small sample size and observational data, however it lends support to the current recommendation of echinocandin based therapy as a viable treatment option for Candida endocarditis.  

    Table 1. 

     

    Amphotericin B

    (N=11)

    Echinocandin

    (N=14)

    p-value

    Combination therapy

    6 (54%)

    6 (43%)

    0.56

    Surgery

    6 (54%)

    5 (36%)

    0.35

    Duration antifungal, days (median)

    78

    50

    0.89

    Suppressive therapy

    5 (45%)

    6 (43%)

    0.90

    Mortality

     

     

     

    42 d

    4 (36%)

    5 (36%)

    1

    1 y

    7 (64%)

    9 (69%)

    1

    Christopher Arnold, MD1, Melissa Johnson, PharmD1, Suzanne Bradley, MD, FIDSA, FSHEA2, Efthymia Giannitsioti, MD, ID3,4,5, Nuria Fernandez-Hidalgo, MD6, Pierre Tattevin7, Jacob Strahilevitz, MD8, Denis Spelman, MBBS FRACP FRCPA MPH9, Eugene Athan, MBBS, FRACP, MPH10, Francisco Nacinovich, MD11,12, Cristiane Lamas, MD, PhD13 and Vivian Chu, MD1, (1)Duke University Medical Center, Durham, NC, (2)Internal Medicine, University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI, (3)Intl. International Collaboration on Endocarditis, Durham, NC, (4)ATTIKON, Athens, Greece, (5)4th Dept of Internal Medicine, Athens Medical School, Athens, Greece, (6)Hospital Vall D'hebron, Barcelona, Spain, (7)Pontchaillou University Hospital, Rennes, France, (8)Hadassah Medical Center, Jerusalem, Israel, (9)Dept. of Microbiol. & Infectious Diseases Unit, Alfred Hosp., Melbourne, Australia, (10)Infectious Diseases, Barwon Health, Geelong, Australia, (11)Fundación Centro de Estudios Infectológicos, Ciudad Autónoma de Buenos Aires, Argentina, (12)Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, (13)Instituto Nacional de Cardiologia, Rio De Janerio, Brazil

    Disclosures:

    C. Arnold, None

    M. Johnson, Astellas: Grant Investigator, Research grant
    Charles River Laboratories: Grant Investigator, Research grant

    S. Bradley, None

    E. Giannitsioti, None

    N. Fernandez-Hidalgo, None

    P. Tattevin, None

    J. Strahilevitz, None

    D. Spelman, None

    E. Athan, None

    F. Nacinovich, None

    C. Lamas, None

    V. Chu, Merck: Grant Investigator, Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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