Prosthetic Valve Candida spp. Endocarditis: New Insights into Long-term Prognosis-The ESCAPE Study

Rivoisy, C.; Vena, A.; Schaeffer, L.; Charlier, C.; Fontanet, A.; Delahaye, F.; Bouza, E.; Lortholary, O.; Munoz, P.; Lefort, A.; Yazdanpanah, Y.; Wolff, M.; Houze, S.; Ferry, T.; Wallon, M.; Strady, C.; Toubas, D.; Brechot, N.; Henry, B.; Fekkar, A.; Fourme, T.; Amouroux, I.; Mainardi, J. -L.; Dannaoui, E.; Rogeaux, O.; Levast, M.; Chirouze, C.; Million, L.; Bastides, F.; Chandenier, J.; Lancon, J. -P.; Ovize, A.; Abgueguen, P.; Bouchara, J. -P.; Tric, L.; Habib, G.; Gourriet, F.; Aaron, L.; Bougnoux, M. E.; Camou, F.; Accoceberry, I.; Sanchez, F. F.; Noureddine, M.; Rosas, G.; De La Torre Lima, J.; Aramendi, J.; Bereciartua, E.; Victoria Boado, M.; Campana Lazaro, M.; Goikoetxea, J.; Jose Goiti, J.; Hernandez, J. L.; Iruretagoyena, J. R.; Zuazabal, J. I.; Lopez-Soria, L.; Montejo, M.; Perez, P. M.; Rodriguez, R.; Voces, R.; Lopez, M. V. G.; Georgieva, R. I.; Solero, M. M.; Bailon, I. R.; Morales, J. R.; Cuende, A. M.; Echeverria, T.; Fuerte, A.; Gaminde, E.; Goenaga, M. A.; Idigoras, P.; Iribarren, J. A.; Yarza, A. I.; Urkola, X. K.; Reviejo, C.; Carrasco, R.; Climent, V.; Llamas, P.; Merino, E.; Plazas, J.; Reus, S.; Alvarez, N.; Bravo-Ferrer, J. M.; Castelo, L.; Cuenca, J.; Llinares, P.; Rey, E. M.; Mayo, M. R.; Sanchez, E.; Regueiro, D. S.; Martinez, F. J.; Del Mar Alonso, M.; Castro, B.; Marrero, D. G.; Duran, M. D. C.; Gomez, M. A. M.; Calzada, J. L.; Nassar, I.; Ciezar, A. P.; Iglesias, J. M. R.; Asensio, V.; Alvarez,; Costas, C.; De La Hera, J.; Suarez, J. F.; Fraile, L. I.; Arguero, V. L.; Menendez, J. L.; Menciabajo, P.; Morales, C.; Torrico, A. M.; Palomo, C.; Martinez, B. P.; Esteban, A. R.; Garcia, R. R.; Asensio, M. T.; Almela, M.; Armero, Y.; Azqueta, M.; Brunet, M.; Cartana, R.; Cervera, C.; Falces, C.; Fita, G.; Fuster, D.; De La Maria, C. G.; Gatell, J. M.; Perez, J. L.; Marco, F.; Mestres, C. A.; Miro, J. M.; Moreno, A.; Ninot, S.; Quintana, E.; Pare, C.; Pericas, J. M.; Pomar, J. L.; Ramirez, J.; Rovira, I.; Sitges, M.; Soy, D.; Tellez, A.; Vila, J.; Bermejo, J.; Cuerpo, G.; De Egea, V.; Eworo, A.; Cruz, A. F.; Leoni, M. E. G.; Del Vecchio, M. G.; Ramallo, V. G.; Hernandez, M. K.; Marin, M.; Martinez-Selles, M.; Menarguez, M. C.; Rincon, C.; Rodriguez-Abella, H.; Rodriguez-Creixems, M.; Pinilla, B.; Pinto, A.; Valerio, M.; Moreno, E. V.; Antorrena, I.; Loeches, B.; Moreno, M.; Ramirez, U.; Baston, V. R.; Romero, M.; Saldana, A.; Castillo, C. A.; Arnaiz, A.; Berrazueta, J.; Bellisco, S.; Belaustegui, M. C.; Duran, R.; Farinas, M.; Farinas-Alvarez, C.; Izquierdo, R. G.; Rico, C. G.; Diez, J. G.; Duran, R. M.; Pajaron, M.; Parra, J. A.; Teira, R.; Zarauza, J.; Pavia, P. G.; Gonzalez, J.; Orden, B.; Ramos, A.; Centella, T.; Hermida, J. M.; Luis Moya, J.; Martin-Davila, P.; Navas, E.; Oliva, E.; Del Rio, A.; Ruiz, S.; Tenorio, C. H.; De Castro, A.; De Cueto, M.; Gallego, P.; Acebal, J. G.; Bano, J. R.; De Alarcon, A.; Garcia, E.; Haro, J. L.; Lepe, J. A.; Lopez, F.; Luque, R.; Alonso, L. J.; Gutierrez, J. M. A.; Blanco, J. R.; Garcia, L.; Oteo, J. A.; De Benito, N.; Gurgui, M.; Pacho, C.; Pericas, R.; Pons, G.; Alvarez, M.; Fernandez, A. L.; Amparomartinez,; Prieto, A.; Regueiro, B.; Tijeira, E.; Vega, M.; Blasco, A. C.; Mollar, J. C.; Arana, J. C. G.; Uriarte, O. G.; Lopez, A. M.; De Zarate, Z. O.; Matos, J. A. U.; Nacle, M. B.; Sanchez-Porto, A.; Vallejo, L.; Arribasleal, J. M.; Vazquez, E. G.; Torres, A. H.; Blazquez, A.; De La Morena Valenzuela, G.; Alonso, A.; Aramburu, J.; Calvo, F. E.; Rodriguez, A. M.; Tarabini-Castellani, P.; Galvez, E. H.; Bellido, C. M.; Pau, J. L.; Sepulveda, M. A.; Sierra, P. T.; Iqbal-Mirza, S. Z.; Alcolea, E. C.; Serrano, P. E.; Roca, J. J. H.

doi:10.1093/cid/cix913

Background. Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. Methods. We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Results. Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confdence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. Conclusion. L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.

Prosthetic Valve Candida spp. Endocarditis: New Insights into Long-term Prognosis-The ESCAPE Study

Rivoisy C.;Vena A.;Schaeffer L.;Charlier C.;Fontanet A.;Delahaye F.;Bouza E.;Lortholary O.;Munoz P.;Lefort A.;Yazdanpanah Y.;Wolff M.;Houze S.;Ferry T.;Wallon M.;Strady C.;Toubas D.;Brechot N.;Henry B.;Fekkar A.;Fourme T.;Amouroux I.;Mainardi J. -L.;Dannaoui E.;Rogeaux O.;Levast M.;Chirouze C.;Million L.;Bastides F.;Chandenier J.;Lancon J. -P.;Ovize A.;Abgueguen P.;Bouchara J. -P.;Tric L.;Habib G.;Gourriet F.;Aaron L.;Bougnoux M. E.;Camou F.;Accoceberry I.;Sanchez F. F.;Noureddine M.;Rosas G.;De La Torre Lima J.;Aramendi J.;Bereciartua E.;Victoria Boado M.;Campana Lazaro M.;Goikoetxea J.;Jose Goiti J.;Hernandez J. L.;Iruretagoyena J. R.;Zuazabal J. I.;Lopez-Soria L.;Montejo M.;Perez P. M.;Rodriguez R.;Voces R.;Lopez M. V. G.;Georgieva R. I.;Solero M. M.;Bailon I. R.;Morales J. R.;Cuende A. M.;Echeverria T.;Fuerte A.;Gaminde E.;Goenaga M. A.;Idigoras P.;Iribarren J. A.;Yarza A. I.;Urkola X. K.;Reviejo C.;Carrasco R.;Climent V.;Llamas P.;Merino E.;Plazas J.;Reus S.;Alvarez N.;Bravo-Ferrer J. M.;Castelo L.;Cuenca J.;Llinares P.;Rey E. M.;Mayo M. R.;Sanchez E.;Regueiro D. S.;Martinez F. J.;Del Mar Alonso M.;Castro B.;Marrero D. G.;Duran M. D. C.;Gomez M. A. M.;Calzada J. L.;Nassar I.;Ciezar A. P.;Iglesias J. M. R.;Asensio V.;Alvarez;Costas C.;De La Hera J.;Suarez J. F.;Fraile L. I.;Arguero V. L.;Menendez J. L.;Menciabajo P.;Morales C.;Torrico A. M.;Palomo C.;Martinez B. P.;Esteban A. R.;Garcia R. R.;Asensio M. T.;Almela M.;Armero Y.;Azqueta M.;Brunet M.;Cartana R.;Cervera C.;Falces C.;Fita G.;Fuster D.;De La Maria C. G.;Gatell J. M.;Perez J. L.;Marco F.;Mestres C. A.;Miro J. M.;Moreno A.;Ninot S.;Quintana E.;Pare C.;Pericas J. M.;Pomar J. L.;Ramirez J.;Rovira I.;Sitges M.;Soy D.;Tellez A.;Vila J.;Bermejo J.;Cuerpo G.;De Egea V.;Eworo A.;Cruz A. F.;Leoni M. E. G.;Del Vecchio M. G.;Ramallo V. G.;Hernandez M. K.;Marin M.;Martinez-Selles M.;Menarguez M. C.;Rincon C.;Rodriguez-Abella H.;Rodriguez-Creixems M.;Pinilla B.;Pinto A.;Valerio M.;Moreno E. V.;Antorrena I.;Loeches B.;Moreno M.;Ramirez U.;Baston V. R.;Romero M.;Saldana A.;Castillo C. A.;Arnaiz A.;Berrazueta J.;Bellisco S.;Belaustegui M. C.;Duran R.;Farinas M.;Farinas-Alvarez C.;Izquierdo R. G.;Rico C. G.;Diez J. G.;Duran R. M.;Pajaron M.;Parra J. A.;Teira R.;Zarauza J.;Pavia P. G.;Gonzalez J.;Orden B.;Ramos A.;Centella T.;Hermida J. M.;Luis Moya J.;Martin-Davila P.;Navas E.;Oliva E.;Del Rio A.;Ruiz S.;Tenorio C. H.;De Castro A.;De Cueto M.;Gallego P.;Acebal J. G.;Bano J. R.;De Alarcon A.;Garcia E.;Haro J. L.;Lepe J. A.;Lopez F.;Luque R.;Alonso L. J.;Gutierrez J. M. A.;Blanco J. R.;Garcia L.;Oteo J. A.;De Benito N.;Gurgui M.;Pacho C.;Pericas R.;Pons G.;Alvarez M.;Fernandez A. L.;Amparomartinez;Prieto A.;Regueiro B.;Tijeira E.;Vega M.;Blasco A. C.;Mollar J. C.;Arana J. C. G.;Uriarte O. G.;Lopez A. M.;De Zarate Z. O.;Matos J. A. U.;Nacle M. B.;Sanchez-Porto A.;Vallejo L.;Arribasleal J. M.;Vazquez E. G.;Torres A. H.;Blazquez A.;De La Morena Valenzuela G.;Alonso A.;Aramburu J.;Calvo F. E.;Rodriguez A. M.;Tarabini-Castellani P.;Galvez E. H.;Bellido C. M.;Pau J. L.;Sepulveda M. A.;Sierra P. T.;Iqbal-Mirza S. Z.;Alcolea E. C.;Serrano P. E.;Roca J. J. H.

2018-01-01

Abstract

Background. Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. Methods. We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Results. Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confdence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. Conclusion. L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.