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Clin Infect Dis. 2018 Mar 5;66(6):825-832. doi: 10.1093/cid/cix913.

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis-The ESCAPE Study.

Collaborators (249)

Yazdanpanah Y, Wolff M, Houzé S, Ferry T, Wallon M, Strady C, Toubas D, Brechot N, Henry B, Fekkar A, Fourme T, Amouroux I, Mainardi JL, Dannaoui E, Rogeaux O, Levast M, Chirouze C, Million L, Bastides F, Chandenier J, Lançon JP, Ovize A, Abgueguen P, Bouchara JP, Tric L, Habib G, Gourriet F, Aaron L, O L, Bougnoux ME, Camou F, Accoceberry I, Sánchez FF, Noureddine M, Rosas G, de la Torre Lima J, Aramendi J, Bereciartua E, Victoria Boado M, Campaña Lázaro M, Goikoetxea J, José Goiti J, Hernández JL, Iruretagoyena JR, Zuazabal JI, López-Soria L, Montejo M, Pérez PM, Rodríguez R, Voces R, López MVG, Georgieva RI, Solero MM, Bailón IR, Morales JR, Cuende AM, Echeverría T, Fuerte A, Gaminde E, Goenaga MÁ, Idígoras P, Iribarren JA, Yarza AI, Urkola XK, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Álvarez N, Bravo-Ferrer JM, Castelo L, Cuenca J, Llinares P, Rey EM, Mayo MR, Sánchez E, Regueiro DS, Martínez FJ, Del Mar Alonso M, Castro B, Marrero DG, Durán MDC, Gómez MAM, Calzada J, Nassar I, Ciezar AP, Iglesias JMR, Asensio V, Álvarez, Costas C, de la Hera J, Suárez JF, Fraile LI, Arguero VL, Menéndez JL, MenciaBajo P, Morales C, Torrico AM, Palomo C, Martínez BP, Esteban ÁR, García RR, Asensio MT, Almela M, Armero Y, Azqueta M, Brunet M, Cartañá R, Cervera C, Falces C, Fita G, Fuster D, de la Maria CG, Gatell JM, Pérez JL, Marco F, Mestres CA, Miró JM, Moreno A, Ninot S, Quintana E, Paré C, Pericás JM, Pomar JL, Ramírez J, Rovira I, Sitges M, Soy D, Téllez A, Vila J, Bermejo J, E B, Cuerpo G, de Egea V, Eworo A, Cruz AF, Leoni MEG, Del Vecchio MG, Ramallo VG, Hernández MK, Marín M, Martínez-Sellés M, Menárguez MC, Muñoz P, Rincón C, Rodríguez-Abella H, Rodríguez-Créixems M, Pinilla B, Pinto Á, Valerio M, Moreno EV, Antorrena I, Loeches B, Moreno M, Ramírez U, Bastón VR, Romero M, Saldaña A, Castillo CA, Arnaiz A, Berrazueta J, Bellisco S, Belaustegui MC, Durán R, Fariñas M, Fariñas-Álvarez C, Mazarrasa CF, Izquierdo RG, Rico CG, Díez JG, Durán RM, Pajarón M, Parra JA, Teira R, Zarauza J, Pavía PG, González J, Orden B, Ramos A, González ER, Centella T, Hermida JM, Luis Moya J, Martín-Dávila P, Navas E, Oliva E, Del Río A, Ruiz S, Tenorio CH, de Castro A, de Cueto M, Gallego P, Acebal JG, Baño JR, de Alarcón A, García E, Haro JL, Lepe JA, López F, Luque R, Alonso LJ, Gutiérrez JMA, Blanco JR, García L, Oteo JA, de Benito N, Gurguí M, Pacho C, Pericas R, Pons G, Álvarez M, Fernández AL, AmparoMartínez, Prieto A, Regueiro B, Tijeira E, Vega M, Blasco AC, Mollar JC, Arana JCG, Uriarte OG, López AM, de Zárate ZO, Matos JAU, Nacle MB, Sánchez-Porto A, Vallejo L, ArribasLeal JM, Vázquez EG, Torres AH, Blázquez A, de la Morena Valenzuela G, Alonso Á, Aramburu J, Calvo FE, Rodríguez AM, Tarabini-Castellani P, Gálvez EH, Bellido CM, Pau JL, Sepúlveda MA, Sierra PT, Iqbal-Mirza SZ, Alcolea EC, Serrano PE, Hernández Roca JJ.

Author information

1
Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France.
2
Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain.
3
Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain.
4
CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain.
5
Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain.
6
Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France.
7
PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France.
8
Hospices Civils de Lyon, Université Claude Bernard Lyon 1, France.
9
Hospital General Universitario Gregorio Marañón, Madrid Spain.
10
Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Clichy, France.
11
IAME, UMR1137, Université Paris-Diderot, Sorbonne Paris Cité, Clichy, France.
12
Service de Médecine Interne, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val-de-Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France.

Abstract

Background:

Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.

Methods:

We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.

Results:

Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.

Conclusion:

L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.

PMID:
29077791
DOI:
10.1093/cid/cix913

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