Background: The length, type of antifungal therapy and outcomes in patients who develop candidemia after documented bacterial endocarditis (BE) is controversial. We are presenting the treatment outcomes for primary candida endocarditis (CE) or ventricular assist device (VAD) and for candidemia after a primary BE. Methods: This retrospective chart review of all patients with primary CE or candidemia with either a VAD or after recent BE from 2003 to 2005. CE was documented by transthoracic (TTE) or transesophageal (TEE) echocardiography. We assessed antifungal treatment, length of therapy, surgical interventions and clinical outcomes. Results: There were 23 patients evaluated. Primary CE (C. albicans = 2, C. lusitaniae = 1) occurred in 3 patients, all were treated medically (median 21 days), with 1 death. Five patients had VAD infections (4 with C. parapsillosis, 1 with C. albicans), all received caspofungin (median 21 days) with the only survivor getting a transplant. There were 15 patients with prior BE (13 S. aureus, 1 S. epidermidis and 1 Enterobacter) who had subsequent candidemia (Table 1). TTE showed 4/15 patients had new vegetations. 9 of 11 patients without vegetations were successfully treated with a median of 14 days of antifungal therapy with one death due to Enterobacter sepsis. Two patients received 6-week courses without any relapse. Of the 4 patients with new vegetations, 3 had right atrial thrombi and received 6 weeks treatment while 1 had prosthetic mitral valve infection and was treated for 4 weeks after valve surgery. The antifungal therapy used did not affect outcomes as all patients received an agent that had activity against their Candida sp. Conclusion: Candidemia in patients with VAD present is associated with high mortality. Patients with candidemia after previous BE can be treated for 2 weeks with any active antifungals provided there is no new vegetation present. Outcomes of Candidemia after BE.
Full conference title:
Infectious Diseases Society of America, 44th Annual Meeting
- IDSA 44th