Outcomes in patients with fungal endocarditis: A multicenter observational cohort study

•Patients with isolated right-sided fungal endocarditis had better survival.•Heart failure/medical treatment only were related to death in Candida endocarditis.•Isolated right-sided endocarditis a less harmful illness in Candida endocarditis. To compare the clinical and epidemiological features, tre...

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Bibliographic Details
Published in:	International journal of infectious diseases 2018-12, Vol.77, p.48-52
Main Authors:	Siciliano, Rinaldo Focaccia, Gualandro, Danielle Menosi, Sejas, Odeli Nicole Encinas, Ignoto, Bruno Giuliano, Caramelli, Bruno, Mansur, Alfredo Jose, Sampaio, Roney Orismar, Pierrotti, Ligia Camera, Barbosa, Giovanna, Golebiovski, Wilma, Weksler, Clara, Lamas, Cristiane, Fortes, Natália Rodrigues Querido, Fortes, Claudio Querido, Tarasoutchi, Flavio, Strabelli, Tania Mara Varejão
Format:	Article
Language:	eng
Subjects:	Adult Amphotericin B - therapeutic use Antifungal Agents - therapeutic use Candida Candida - drug effects Candida - isolation & purification Echinocandins - therapeutic use Endocarditis Endocarditis - drug therapy Endocarditis - mortality Female Fluconazole - therapeutic use Follow-Up Studies Fungi Heart Failure - drug therapy Heart Failure - microbiology Heart Failure - mortality Hospital Mortality Humans Male Middle Aged Mycoses - drug therapy Mycoses - mortality Retrospective Studies Risk Factors Treatment Outcome
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Summary:	•Patients with isolated right-sided fungal endocarditis had better survival.•Heart failure/medical treatment only were related to death in Candida endocarditis.•Isolated right-sided endocarditis a less harmful illness in Candida endocarditis. To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis. A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality. Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023). Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.
ISSN:	1201-9712 1878-3511