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Tipo
ArtículoDerechos de autor
Acceso abierto
Fecha del embargo
2020-02-12
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- INI - Artigos de Periódicos [3496]
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CANDIDA INFECTIVE ENDOCARDITIS: AN OBSERVATIONAL COHORT STUDY WITH A FOCUS ON THERAPY
Autor
Arnold, Christopher J.
Johnson, Melissa
Bayer, Arnold S.
Bradley, Suzanne
Giannitsioti, Efthymia
Miró, José M.
Tornos, Pilar
Tattevin, Pierre
Strahilevitz, Jacob
Spelman, Denis
Athan, Eugene
Nacinovich, Francisco
Fortes, Claudio Q.
Lamas, Cristiane
Barsic, Bruno
Fernández-Hidalgo, Nuria
Muñoz, Patricia
Chu, Vivian H.
ICE Investigators
Johnson, Melissa
Bayer, Arnold S.
Bradley, Suzanne
Giannitsioti, Efthymia
Miró, José M.
Tornos, Pilar
Tattevin, Pierre
Strahilevitz, Jacob
Spelman, Denis
Athan, Eugene
Nacinovich, Francisco
Fortes, Claudio Q.
Lamas, Cristiane
Barsic, Bruno
Fernández-Hidalgo, Nuria
Muñoz, Patricia
Chu, Vivian H.
ICE Investigators
Afiliación
Duke University Medical Center. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Harbor-UCLA Medical Center. Los Angeles, CA, USA.
University of Michigan. Ann Arbor, MI, USA / VA Ann Arbor Healthcare System. Ann Arbor, MI, USA.
Attikon University General Hospital. Athens, Greece.
University of Barcelona. Hospital Clinic-IDIBAPS. Barcelona, Spain.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d’Hebron. Barcelona, Spain.
Pontchaillou University. Rennes, France.
Hadassah-Hebrew University. Jerusalem, Israel.
Alfred Hospital and Monash University. Melbourne, Australia.
Barwon Health. Geelong, Australia.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Rio de Janeiro, RJ, Brasil.
Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Duque de Caxias, RJ, Brasil.
University Hospital for Infectious Diseases. Zagreb, Croatia.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d’Hebron. Barcelona, Spain.
Hospital General Universitario Gregorio Marañón. Madrid, Spain.
Duke University Medical Center. Durham, NC, USA.
Duke University Medical Center. Durham, NC, USA.
Harbor-UCLA Medical Center. Los Angeles, CA, USA.
University of Michigan. Ann Arbor, MI, USA / VA Ann Arbor Healthcare System. Ann Arbor, MI, USA.
Attikon University General Hospital. Athens, Greece.
University of Barcelona. Hospital Clinic-IDIBAPS. Barcelona, Spain.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d’Hebron. Barcelona, Spain.
Pontchaillou University. Rennes, France.
Hadassah-Hebrew University. Jerusalem, Israel.
Alfred Hospital and Monash University. Melbourne, Australia.
Barwon Health. Geelong, Australia.
Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina.
Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Rio de Janeiro, RJ, Brasil.
Instituto Nacional de Cardiologia. Rio de Janeiro, RJ, Brasil / Universidade do Grande Rio. Duque de Caxias, RJ, Brasil.
University Hospital for Infectious Diseases. Zagreb, Croatia.
Universitat Autònoma de Barcelona. Hospital Universitari Vall d’Hebron. Barcelona, Spain.
Hospital General Universitario Gregorio Marañón. Madrid, Spain.
Duke University Medical Center. Durham, NC, USA.
Resumen en ingles
Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.
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