Outcomes in patients with fungal endocarditis: a multicenter observational cohort study.
Int J Infect Dis. 2018 Sep 21;:
Authors: Siciliano RF, Gualandro DM, Sejas ONE, Ignoto BG, Caramelli B, Mansur AJ, Sampaio RO, Pierrotti LC, Barbosa G, Golebiovski W, Lamas CWC, Fortes NRQ, Fortes CQ, Tarasoutchi F, Strabelli TMV
PURPOSE: To compare the clinical and epidemiological features, treatment and outcome 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.
METHODS: A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. We compared clinical features 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.
RESULTS: 78 patients with fungal endocarditis were studied, median age of 50 years; 55% were men 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 (OR 5.0; p=0.027) and exclusive medical treatment (OR 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 (OR 0.13; p=0.023).
CONCLUSIONS: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features, 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.
PMID: 30248465 [PubMed – as supplied by publisher]