Candida endocarditis: systematic literature review from 1997 to 2014 and analysis of 29 cases from the Italian Study of Endocarditis

ABSTRACT

Introduction: Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease.

Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality.

Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.

KEYWORDS:

• Candida
• endocarditis
• candidemia
• intestinal translocation
• biofilm
• echinocandin
• amphotericin
• triazole

Acknowledgments

SEI investigators: Alberto Biglino, Maria Teresa Brusa, Paolo Crivelli and Roberta Moglia (Asti); Sebastiano Leone and Fredy Suter (Bergamo); Peter Mian and Greta Spoladore (Bolzano); Francesco Castelli, Silvia Magri and Roberto Stellini (Brescia); Domenico Di Caprio (Caserta); Evelyn Van Hauwermeiren, Angelo Pan and Fabio Zacchi (Cremona); Nicoletta Barzaghi (Cuneo); Marco Libanore and Mario Pantaleoni (Ferrara); Valerio Del Bono and Claudio Viscoli (Genova); Gianni Gattuso and Alfredo Scalzini (Mantova); Maria Riccarda Villa (Milano); Mariano Bernardo, Roberta Casillo, Susanna Cuccurullo, Giovanni Dialetto, Irene Mattucci, Enrico Ragone, Marie-Françoise Tripodi and Riccardo Utili (Napoli); Francesco Barbaro and Elke Erne (Padova); Lorenzo Minoli and Elena Maria Seminari (Pavia); Laura Martinelli, Carlo Pallotto (Perugia); Benedetta Canovari and Laura Stoppini (Pesaro); Pierangelo Chinello and Nicola Petrosillo (Roma); Palma Delle Foglie (Trento); Mario Giobbia, Walter Inoiosa, Pier Giorgio Scotton and Alberto Vaglia (Treviso); Massimo Crapis and Sergio Venturini (Udine); Daniela Dalla Gasperina, Paolo Grossi and Alessandro Tebini (Varese); Ercole Concia, Paola Del Bravo and Andrea Tedesco (Verona); Roberto Nicolin and Giampietro Pellizzer (Vicenza).

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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Additional information

Funding

The manuscript was not funded.