Outcomes in patients with fungal endocarditis: A multicenter observational cohort study

Objective: To compare the clinical and epidemiological features, treatments, and outcomes 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...

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Main Authors: Rinaldo Focaccia Siciliano, Danielle Menosi Gualandro, Odeli Nicole Encinas Sejas, Bruno Giuliano Ignoto, Bruno Caramelli, Alfredo Jose Mansur, Roney Orismar Sampaio, Ligia Camera Pierrotti, Giovanna Barbosa, Wilma Golebiovski, Clara Weksler, Cristiane Lamas, Natália Rodrigues Querido Fortes, Claudio Querido Fortes, Flavio Tarasoutchi, Tania Mara Varejão Strabelli
Format: Article
Language:English
Published: Elsevier 2018-12-01
Series:International Journal of Infectious Diseases
Online Access:http://www.sciencedirect.com/science/article/pii/S1201971218345284
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author Rinaldo Focaccia Siciliano
Danielle Menosi Gualandro
Odeli Nicole Encinas Sejas
Bruno Giuliano Ignoto
Bruno Caramelli
Alfredo Jose Mansur
Roney Orismar Sampaio
Ligia Camera Pierrotti
Giovanna Barbosa
Wilma Golebiovski
Clara Weksler
Cristiane Lamas
Natália Rodrigues Querido Fortes
Claudio Querido Fortes
Flavio Tarasoutchi
Tania Mara Varejão Strabelli
spellingShingle Rinaldo Focaccia Siciliano
Danielle Menosi Gualandro
Odeli Nicole Encinas Sejas
Bruno Giuliano Ignoto
Bruno Caramelli
Alfredo Jose Mansur
Roney Orismar Sampaio
Ligia Camera Pierrotti
Giovanna Barbosa
Wilma Golebiovski
Clara Weksler
Cristiane Lamas
Natália Rodrigues Querido Fortes
Claudio Querido Fortes
Flavio Tarasoutchi
Tania Mara Varejão Strabelli
Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
International Journal of Infectious Diseases
author_facet Rinaldo Focaccia Siciliano
Danielle Menosi Gualandro
Odeli Nicole Encinas Sejas
Bruno Giuliano Ignoto
Bruno Caramelli
Alfredo Jose Mansur
Roney Orismar Sampaio
Ligia Camera Pierrotti
Giovanna Barbosa
Wilma Golebiovski
Clara Weksler
Cristiane Lamas
Natália Rodrigues Querido Fortes
Claudio Querido Fortes
Flavio Tarasoutchi
Tania Mara Varejão Strabelli
author_sort Rinaldo Focaccia Siciliano
title Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
title_short Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
title_full Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
title_fullStr Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
title_full_unstemmed Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
title_sort outcomes in patients with fungal endocarditis: a multicenter observational cohort study
publisher Elsevier
series International Journal of Infectious Diseases
issn 1201-9712
publishDate 2018-12-01
description Objective: To compare the clinical and epidemiological features, treatments, and outcomes 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. Clinical features were compared 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: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male 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 (odds ratio 5.0; p = 0.027) and exclusive medical treatment (odds ratio 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 (odds ratio 0.13; p = 0.023). Conclusions: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They 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. Keywords: Endocarditis, Fungi, Candida
url http://www.sciencedirect.com/science/article/pii/S1201971218345284
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spelling doaj-0bc05feabe3e4840b67de499b5be61bd2020-11-24T21:24:38ZengElsevierInternational Journal of Infectious Diseases1201-97122018-12-01774852Outcomes in patients with fungal endocarditis: A multicenter observational cohort studyRinaldo Focaccia Siciliano0Danielle Menosi Gualandro1Odeli Nicole Encinas Sejas2Bruno Giuliano Ignoto3Bruno Caramelli4Alfredo Jose Mansur5Roney Orismar Sampaio6Ligia Camera Pierrotti7Giovanna Barbosa8Wilma Golebiovski9Clara Weksler10Cristiane Lamas11Natália Rodrigues Querido Fortes12Claudio Querido Fortes13Flavio Tarasoutchi14Tania Mara Varejão Strabelli15Infection Control Team, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Corresponding author at: Av. Dr. Eneas de Carvalho Aguiar, 44 andar AB, São Paulo, SP, 05403-000, Brazil.Cardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilInfection Control Team, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilInfection Control Team, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilCardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilCardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilCardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilInfection Control Team, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, BrazilInstituto Nacional de Cardiologia do Rio de Janeiro (INC), Rio de Janeiro, BrazilInstituto Nacional de Cardiologia do Rio de Janeiro (INC), Rio de Janeiro, BrazilInstituto Nacional de Cardiologia do Rio de Janeiro (INC), Rio de Janeiro, BrazilInstituto Nacional de Cardiologia do Rio de Janeiro (INC), Rio de Janeiro, BrazilHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, BrazilHospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro (HUCFF-UFRJ), Rio de Janeiro, BrazilCardiology Department, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilInfection Control Team, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, BrazilObjective: To compare the clinical and epidemiological features, treatments, and outcomes 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. Clinical features were compared 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: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male 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 (odds ratio 5.0; p = 0.027) and exclusive medical treatment (odds ratio 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 (odds ratio 0.13; p = 0.023). Conclusions: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They 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. Keywords: Endocarditis, Fungi, Candidahttp://www.sciencedirect.com/science/article/pii/S1201971218345284