Article
Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
Registro en:
SICILIANO, Rinaldo Focaccia et al. Outcomes in patients with fungal endocarditis: a multicenter observational cohort study. International Journal of Infectious Diseases, v. 77, p. 48-52, Dec. 2018.
1201-9712
10.1016/j.ijid.2018.09.016
1878-3511
Autor
Siciliano, Rinaldo Focaccia
Gualandro, Danielle Menosi
Sejas, Odeli Nicole Encinas
Ignoto, Bruno Giuliano
Caramelli, Bruno
Mansur, Alfredo Jose
Sampaio, Roney Orismar
Pierrotti, Ligia Camera
Barbosa, Giovanna
Golebiovski, Wilma
Weksler, Clara
Lamas, Cristiane
Fortes, Natália Rodrigues Querido
Fortes, Claudio Querido
Tarasoutchi, Flavio
Strabelli, Tania Mara Varejão
Resumen
Cristiane Lamas. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento. 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.