Key result
Injection drug use shows no significant link to 12-month mortality in Candida infective endocarditis.
Why the study?
Candida spp. infective endocarditis is rare with high morbidity and mortality, and injection drug use is a recognized risk factor requiring further characterization.
Cohort (n=20)
No
Absolute Event Rate: 39% vs 0%
p-value: p=0.11
Candida infective endocarditis is a rare condition with high long-term mortality (25% at 1 year), predominantly affecting injection drug users.
BACKGROUND: Candida spp. infective endocarditis (CIE) although rare is associated with high morbidity and mortality. Risk factors include prosthetic heart valves and injection drug use (IDU). We reviewed all cases of CIE at our institution to describe the microbiology, treatment and outcomes of patients focusing on IDU as a predisposing factor. METHODS: Retrospective cohort of patients with definite CIE between 2013 and 2019 at a university hospital was analysed. Demographic data collected included IDU, microbiologic, treatment and mortality. The primary outcome of interest was 12-month, all-cause mortality. RESULTS: Twenty patients were included (one had two separate episodes of CIE); CIE accounted for 4% of total infective endocarditis (IE) cases during the study period. The median (IQR) age was 38 (30-58) years, 10 (50%) had a previous history of IE, and 4 (20%) patients had prosthetic heart valves or an implanted cardiac device. Thirteen (65%) patients were IDU. The tricuspid valve was the primary valve involved (8/18, 44%), and C albicans was the most frequently isolated organism (8, 36%). Echinocandin was the most common treatment strategy (8, 40%). Only three (15%) patients underwent valve replacement during hospitalisation. There were no in-hospital fatalities, and 5 (25%) patients died at one year; all were IDU (39% to 0%, p = .11). CONCLUSION: CIE is a rare infectious disease seen more commonly in the IDU population. Cardiac surgery was rarely performed, and long-term mortality was 25%. Additional data are needed to identify ideal management strategies in this population.
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Morelli et al. (2020) conducted a cohort in Candida spp. infective endocarditis (n=20). Injection drug use vs. Non-injection drug use was evaluated on 12-month, all-cause mortality (p=0.11). Among patients with Candida infective endocarditis, injection drug use was associated with a 12-month all-cause mortality of 39%, compared to 0% in non-users (p=0.11).
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