Comparison of characteristics and short-term outcome from fungal infective endocarditis in prosthetic valve endocarditis versus native valve endocarditis

Abstract

Fungal infective endocarditis (IE) is a rare, serious, and potentially lethal disease, yet its clinical characteristics and short-term outcomes remain poorly understood. A detailed comparative analysis of fungal prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE) has not been performed. This study was designed to explore the general characteristics, treatment patterns, and outcomes of patients with fungal IE in a Chinese hospital and compare these data between PVE and NVE. Four hundred ninety-three patients were admitted to Fuwai hospital from January 2002 to December 2010. Fungal IE accounted for 7% (32 cases) of cases. Of these patients, 19 (59%) patients had NVE, 12 (37%) PVE, and 1 (3%) cardiac device-related infective endocarditis (CDRIE). Candida albicans remained the predominant causative pathogen (47% of all IE). Patients with NVE, compared with PVE patients, were older (50 years vs 37 years, p = 0.034), had less frequent history of previous endocarditis (0 vs 25%, p = 0.049), and were more likely to have a history of diabetes (37% vs 0, p = 0.026) and be in an immunocompromised state (37% vs 0, p = 0.026). Nearly half of the patients died of refractory heart failure, followed by severe sepsis and stroke. In-hospital mortality rate was 38%, and the 3-month cumulative mortality rate was 47%. Recurrence of IE was more common in fungal PVE patients (42% vs 5%, p = 0.022) during the 90-day follow-up. In conclusion, fungal IE is associated with high mortality and recurrence rates. Surgery performed in selected cases may improve the outcomes, but the recurrence rate remains high.