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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Fioriti S, Brescini L, Pallotta F, Canovari B, Morroni G, Barchiesi F. Antifungal Combinations against Candida Species: From Bench to Bedside. J Fungi (Basel) 2022; 8:jof8101077. [PMID: 36294642 PMCID: PMC9605143 DOI: 10.3390/jof8101077] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Candida spp. is the major causative agent of fungal infections in hospitalized patients and the fourth most common cause of nosocomial bloodstream infection (BSI). The availability of standardized methods for testing the in vitro activity of antifungals along with the expanding of antifungal armamentarium, the rising of drug-resistance and the persistence of a high mortality rate in systemic candidiasis have led to an increased interest in combination therapy. Therefore, we aimed to review the scientific literature concerning the antifungal combinations against Candida. A literature search performed in PubMed yielded 92 studies published from 2000 to 2021: 29 articles referring to in vitro studies, six articles referring to either in vitro and in vivo (i.e., animal models) studies and 57 clinical articles. Pre-clinical studies involved 735 isolates of Candida species and 12 unique types of antifungal combination approaches including azoles plus echinocandins (19%), polyenes plus echinocandins (16%), polyenes plus azoles (13%), polyenes plus 5-flucytosine ([5-FC], 13%), azoles plus 5-FC (11%) and other types of combinations (28%). Results varied greatly, often being species-, drug- and methodology-dependent. Some combinatorial regimens exerted a synergistic effect against difficult-to-treat Candida species (i.e., azoles plus echinocandins; polyenes plus 5-FC) or they were more effective than monotherapy in prevent or reducing biofilm formation and in speeding the clearance of infected tissues (i.e., polyenes plus echinocandins). In 283 patients with documented Candida infections (>90% systemic candidiasis/BSI), an antifungal combination approach could be evaluated. Combinations included: azoles plus echinocandins (36%), 5-FC-combination therapies (24%), polyenes plus azoles (18%), polyenes plus echinocandins (16%) and other types of combination therapy (6%). Case reports describing combination therapies yielded favorable response in most cases, including difficult-to-treat fungal infections (i.e., endocarditis, osteoarticular infections, CNS infections) or difficult-to-treat fungal pathogens. The only randomized trial comparing amphotericin-B deoxycholate (AMB) plus FLU vs. AMB alone for treatment of BSI in nonneutropenic patients showed that the combination trended toward improved success and more-rapid clearance from the bloodstream. In summary, antifungal combinations against Candida have produced great interest in the past two decades. To establish whether this approach can become a reliable treatment option, additional in vitro and clinical data are warranted.
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Affiliation(s)
- Simona Fioriti
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
| | - Lucia Brescini
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Disease Clinic, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Francesco Pallotta
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Disease Clinic, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
| | - Benedetta Canovari
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
| | - Gianluca Morroni
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-071-220-6298; Fax: +39-071-220-6297
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, 60126 Ancona, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, 61121 Pesaro, Italy
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Fungal endocarditis after type a dissection, a positive outcome from Candida parapsilosis prosthetic aortic valve endocarditis and aortic graft infection: A testament to multidisciplinary practice. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Vitale RG. Role of Antifungal Combinations in Difficult to Treat Candida Infections. J Fungi (Basel) 2021; 7:731. [PMID: 34575770 PMCID: PMC8468556 DOI: 10.3390/jof7090731] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/27/2021] [Accepted: 09/02/2021] [Indexed: 01/23/2023] Open
Abstract
Candida infections are varied and, depending on the immune status of the patient, a life-threatening form may develop. C. albicans is the most prevalent species isolated, however, a significant shift towards other Candida species has been noted. Monotherapy is frequently indicated, but the patient's evolution is not always favorable. Drug combinations are a suitable option in specific situations. The aim of this review is to address this problem and to discuss the role of drug combinations in difficult to treat Candida infections. A search for eligible studies in PubMed and Google Scholar databases was performed. An analysis of the data was carried out to define in which cases a combination therapy is the most appropriate. Combination therapy may be used for refractory candidiasis, endocarditis, meningitis, eye infections and osteomyelitis, among others. The role of the drug combination would be to increase efficacy, reduce toxicity and improve the prognosis of the patient in infections that are difficult to treat. More clinical studies and reporting of cases in which drug combinations are used are needed in order to have more data that support the use of this therapeutic strategy.
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Affiliation(s)
- Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina;
- Unidad de Parasitología, Sector Micología, Hospital J. M. Ramos Mejía, Buenos Aires, Argentina
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Mehta Y, Deswal V. Candida parapsilosis Prosthetic Valve Endocarditis: A Multifaceted Problem. Indian J Crit Care Med 2021; 25:839-840. [PMID: 34733018 PMCID: PMC8559744 DOI: 10.5005/jp-journals-10071-23941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mehta Y, Deswal V. Candida parapsilosis Prosthetic Valve Endocarditis: A Multifaceted Problem. Indian J Crit Care Med 2021;25(8):839-840.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesia, Medanta: The Medicity, Gurugram, Haryana, India
| | - Vikas Deswal
- Department of Internal Medicine and Infectious Diseases, Medanta: The Medicity, Gurugram, Haryana, India
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Su S, Yan H, Min L, Wang H, Chen X, Shi J, Sun S. The antifungal activity of caspofungin in combination with antifungals or non-antifungals against Candida species in vitro and in clinical therapy. Expert Rev Anti Infect Ther 2021; 20:161-178. [PMID: 34128761 DOI: 10.1080/14787210.2021.1941868] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Candida species have been regarded as global health threats due to their ability to cause invasive infections. It is challenging to treat Candida bloodstream infections, which are associated with high mortality levels. Monotherapy with antifungals is sometimes not effective against severe Candida infections, and combination therapy is needed in clinical practice.Areas covered: This review was undertaken based on data from a PubMed search for English language reports published before March 2021 by using the terms 'caspofungin,' 'Candida species,' 'combination therapy,' 'antifungal effect,' and 'novel antifungal agent.'Expert opinion: Combination therapy is an empirical strategy for treating refractory Candida infections. Caspofungin has been recommended to treat candidaemia. Caspofungin in combination therapy has some applications, while the efficacy of combination therapy in the treatment of refractory Candida infections needs more study, such as randomized controlled trials. In addition, novel compounds or drugs with potential antifungal activities have been examined, and some of them exhibit synergistic interactions with caspofungin. Thus, the antifungal activity of caspofungin in combination with antifungals or non-antifungals against Candida species in vitro and in clinical therapy is summarized.
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Affiliation(s)
- Shan Su
- Department of Clinical Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China.,School of Pharmaceutical Sciences, Shandong University, Jinan, People's Republic of China
| | - Haiying Yan
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China
| | - Li Min
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China
| | - Hongmei Wang
- Department of Pharmacy, Zibo Sixth People's Hospital, Zibo, Shandong, People's Republic of China
| | - Xueqi Chen
- School of Pharmaceutical Sciences, Shandong University, Jinan, People's Republic of China
| | - Jinyi Shi
- Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China
| | - Shujuan Sun
- Department of Clinical Pharmacy, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China.,Department of Clinical Pharmacy, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Shandong Medicine and Health Key Laboratory of Clinical Pharmacy, Jinan, People's Republic of China
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Nakatani S, Ohara T, Ashihara K, Izumi C, Iwanaga S, Eishi K, Okita Y, Daimon M, Kimura T, Toyoda K, Nakase H, Nakano K, Higashi M, Mitsutake K, Murakami T, Yasukochi S, Okazaki S, Sakamoto H, Tanaka H, Nakagawa I, Nomura R, Fujiu K, Miura T, Morizane T. JCS 2017 Guideline on Prevention and Treatment of Infective Endocarditis. Circ J 2019; 83:1767-1809. [PMID: 31281136 DOI: 10.1253/circj.cj-19-0549] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Yutaka Okita
- Cardio-Aortic Center, Takatsuki General Hospital
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, the University of Tokyo
| | - Toshimi Kimura
- Department of Pharmacy, Tokyo Women's Medical University Hospital
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Kazuhiko Nakano
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization, Osaka National Hospital
| | - Kotaro Mitsutake
- Department of Infectious Diseases and Infection Control, Saitama Medical University International Medical Center
| | | | | | - Shuhei Okazaki
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Haruo Sakamoto
- Department of Oral and Maxicillofacial Surgery, Tokai University Hachioji Hospital
| | - Hiroshi Tanaka
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University
| | | | - Ryota Nomura
- Division of Oral Infection and Disease Control, Osaka University Graduate School of Dentistry
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, the University of Tokyo
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
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Kubota K, Soma K, Uehara M, Inaba T, Saito A, Takeda N, Hatano M, Morita H, Inuzuka R, Hirata Y, Yao A, Komuro I. Combined Surgical and Medical Therapy for Candida Prosthetic Endocarditis in a Patient with Repaired Tetralogy of Fallot. Int Heart J 2018; 59:877-880. [DOI: 10.1536/ihj.17-314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Kana Kubota
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsura Soma
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masae Uehara
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Akihito Saito
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masaru Hatano
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Ryo Inuzuka
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo
| | - Yasutaka Hirata
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Atsushi Yao
- Division of Health Service Promotion, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Rivoisy C, Vena A, Schaeffer L, Charlier C, Fontanet A, Delahaye F, Bouza E, Lortholary O, Munoz P, Lefort A. Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis-The ESCAPE Study. Clin Infect Dis 2018; 66:825-832. [PMID: 29077791 DOI: 10.1093/cid/cix913] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/24/2017] [Indexed: 02/05/2023] Open
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.
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Affiliation(s)
- Claire Rivoisy
- 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
| | - Antonio Vena
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Laura Schaeffer
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
| | - Caroline Charlier
- 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
| | - Arnaud Fontanet
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
- PACRI Unit, Conservatoire National des Arts et Métiers, Paris, France
| | | | - Emilio Bouza
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
- Hospital General Universitario Gregorio Marañón, Madrid Spain
| | - Olivier Lortholary
- 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
- Institut Pasteur, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, CNRS URA3012, Clichy, France
| | - Patricia Munoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense de Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Universidad Complutense de Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Agnès Lefort
- IAME, UMR1137, Université Paris-Diderot, Sorbonne Paris Cité, Clichy, France
- Service de Médecine Interne, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val-de-Seine, Assistance Publique-Hôpitaux de Paris, Clichy, France
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Giuliano S, Guastalegname M, Russo A, Falcone M, Ravasio V, Rizzi M, Bassetti M, Viale P, Pasticci MB, Durante-Mangoni E, Venditti M. Candida endocarditis: systematic literature review from 1997 to 2014 and analysis of 29 cases from the Italian Study of Endocarditis. Expert Rev Anti Infect Ther 2017; 15:807-818. [PMID: 28903607 DOI: 10.1080/14787210.2017.1372749] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Candida Endocarditis (CE) is a deadly disease. It is of paramount importance to assess risk factors for acquisition of both Candida native (NVE) and prosthetic (PVE) valve endocarditis and relate clinical features and treatment strategies with the outcome of the disease. Areas covered: We searched the literature using the Pubmed database. Cases of CE from the Italian Study on Endocarditis (SEI) were also included. Overall, 140 cases of CE were analyzed. Patients with a history of abdominal surgery and antibiotic exposure had higher probability of developing NVE than PVE. In the PVE group, time to onset of CE was significantly lower for biological prosthesis compared to mechanical prosthesis. In the whole population, greater age and longer time to diagnosis were associated with increased likelihood of death. Patients with effective anti-biofilm treatment, patients who underwent cardiac surgery and patients who were administered chronic suppressive antifungal treatment showed increased survival. For PVE, moderate active anti-biofilm and highly active anti-biofilm treatment were associated with lower mortality. Expert commentary: Both NVE and PVE could be considered biofilm-related diseases, pathogenetically characterized by Candida intestinal translocation and initial transient candidemia. Cardiac surgery, EAB treatment and chronic suppressive therapy might be crucial in increasing patient survival.
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Affiliation(s)
- Simone Giuliano
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Maurizio Guastalegname
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Alessandro Russo
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Marco Falcone
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
| | - Veronica Ravasio
- b Infectious Diseases Unit , ASST Papa Giovanni XXIII , Bergamo , Italy
| | - Marco Rizzi
- b Infectious Diseases Unit , ASST Papa Giovanni XXIII , Bergamo , Italy
| | - Matteo Bassetti
- c Infectious Diseases Division , Santa Maria Misericordia University Hospital , Udine , Italy
| | - Pierluigi Viale
- d Infectious Diseases Unit, Department of Medical and Surgical Sciences , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | | | - Emanuele Durante-Mangoni
- f Department of Clinical and Experimental Medicine , Università della Campania 'Luigi Vanvitelli', AORN dei Colli-Ospedale Monaldi , Naples , Italy
| | - Mario Venditti
- a Department of Public Health and Infectious Diseases , Policlinico Umberto I 'Sapienza' University of Rome , Rome , Italy
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Katragkou A, Roilides E, Walsh TJ. Role of Echinocandins in Fungal Biofilm-Related Disease: Vascular Catheter-Related Infections, Immunomodulation, and Mucosal Surfaces. Clin Infect Dis 2016; 61 Suppl 6:S622-9. [PMID: 26567280 DOI: 10.1093/cid/civ746] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Biofilm-related infections have become an increasingly important clinical problem. Many of these infections occur in patients with multiple comorbidities or with impaired immunity. Echinocandins (caspofungin, micafungin, and anidulafungin) exert their fungicidal activity by inhibition of the synthesis of the (1→3)-β-d-glucan. They are active among in vitro and in vivo model systems against a number of Candida species and filamentous fungi in their planktonic and biofilm phenotype. Their superior activity against biofilms poses them in an advantageous position among the antifungal armamentarium. However, additional studies are warranted to expand our knowledge on the role of echinocandins against biofilm-related infections.
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Affiliation(s)
- Aspasia Katragkou
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, New York
| | - Emmanuel Roilides
- Infectious Disease Unit, Third Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical Center of Cornell University, New York, New York Department of Pediatrics Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York
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12
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Saphina P, Mansoor CA, Jemshad A, Musambil M. Native Valve Candida Endocarditis Complicating Pregnancy after Abdominal Surgery. Heart Views 2016; 16:111-3. [PMID: 27326355 PMCID: PMC4590182 DOI: 10.4103/1995-705x.164459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Candida endocarditis is an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial morbidity and mortality. A 28-year-old primigravida at 32 weeks of gestation was admitted with low-grade fever and lower abdominal pain for 2 weeks. She had undergone open appendicectomy 2 months before admission. Echocardiogram showed a pedunculated 24 mm × 21 mm mass attached to the undersurface of anterior mitral leaflet near the tip and moderate mitral regurgitation. Repeated blood cultures showed growth of nonalbicans candida. She was immediately started on liposomal amphotericin and was taken up for surgery, but despite all efforts she succumbed to her illness.
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Affiliation(s)
- P Saphina
- Department of Gynaecology, M.E.S. Medical College, Perinthalmanna, Kerala, India
| | - C A Mansoor
- Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Kerala, India
| | - A Jemshad
- Department of General Medicine, M.E.S. Medical College, Perinthalmanna, Kerala, India
| | - Mohthash Musambil
- Department of Research, M.E.S. Medical College, Perinthalmanna, Kerala, India
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Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, Reboli AC, Schuster MG, Vazquez JA, Walsh TJ, Zaoutis TE, Sobel JD. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1-50. [PMID: 26679628 PMCID: PMC4725385 DOI: 10.1093/cid/civ933] [Citation(s) in RCA: 1872] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 02/06/2023] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
| | - Carol A Kauffman
- Veterans Affairs Ann Arbor Healthcare System and University of Michigan Medical School, Ann Arbor
| | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Thomas J Walsh
- Weill Cornell Medical Center and Cornell University, New York, New York
| | | | - Jack D Sobel
- Harper University Hospital and Wayne State University, Detroit, Michigan
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Shetty N, Nagpal D, Koivu S, Mrkobrada M. Surgical and Medical Management of Isolated Tricuspid Valve Infective Endocarditis in Intravenous Drug Users. J Card Surg 2015; 31:83-8. [DOI: 10.1111/jocs.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nabha Shetty
- Department of Medicine; Dalhousie University; Halifax Nova Scotia
| | - Dave Nagpal
- Division of Cardiac Surgery and Intensive Care; Western University; London Ontario
| | - Sharon Koivu
- Division of Palliative Care; Western University; London Ontario
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16
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Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075-3128. [PMID: 26320109 DOI: 10.1093/eurheartj/ehv319] [Citation(s) in RCA: 3136] [Impact Index Per Article: 348.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
MESH Headings
- Acute Kidney Injury/diagnosis
- Acute Kidney Injury/therapy
- Ambulatory Care
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/therapy
- Anti-Bacterial Agents/therapeutic use
- Antibiotic Prophylaxis
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Clinical Laboratory Techniques
- Critical Care
- Cross Infection/etiology
- Dentistry, Operative
- Diagnostic Imaging/methods
- Embolism/diagnosis
- Embolism/therapy
- Endocarditis/diagnosis
- Endocarditis/therapy
- Endocarditis, Non-Infective/diagnosis
- Endocarditis, Non-Infective/therapy
- Female
- Fibrinolytic Agents/therapeutic use
- Heart Defects, Congenital
- Heart Failure/diagnosis
- Heart Failure/therapy
- Heart Valve Diseases/diagnosis
- Heart Valve Diseases/therapy
- Humans
- Long-Term Care
- Microbiological Techniques
- Musculoskeletal Diseases/diagnosis
- Musculoskeletal Diseases/microbiology
- Musculoskeletal Diseases/therapy
- Myocarditis/diagnosis
- Myocarditis/therapy
- Neoplasms/complications
- Nervous System Diseases/diagnosis
- Nervous System Diseases/microbiology
- Nervous System Diseases/therapy
- Patient Care Team
- Pericarditis/diagnosis
- Pericarditis/therapy
- Postoperative Complications/etiology
- Postoperative Complications/prevention & control
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/therapy
- Prognosis
- Prosthesis-Related Infections/diagnosis
- Prosthesis-Related Infections/therapy
- Recurrence
- Risk Assessment
- Risk Factors
- Splenic Diseases/diagnosis
- Splenic Diseases/therapy
- Thoracic Surgical Procedures
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17
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Candida infective endocarditis: an observational cohort study with a focus on therapy. Antimicrob Agents Chemother 2015; 59:2365-73. [PMID: 25645855 DOI: 10.1128/aac.04867-14] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Candida infective endocarditis is a rare disease with a high mortality rate. Our understanding of this infection is derived from case series, case reports, and small prospective cohorts. The purpose of this study was to evaluate the clinical features and use of different antifungal treatment regimens for Candida infective endocarditis. This prospective cohort study was based on 70 cases of Candida infective endocarditis from the International Collaboration on Endocarditis (ICE)-Prospective Cohort Study and ICE-Plus databases collected between 2000 and 2010. The majority of infections were acquired nosocomially (67%). Congestive heart failure (24%), prosthetic heart valve (46%), and previous infective endocarditis (26%) were common comorbidities. Overall mortality was high, with 36% mortality in the hospital and 59% at 1 year. On univariate analysis, older age, heart failure at baseline, persistent candidemia, nosocomial acquisition, heart failure as a complication, and intracardiac abscess were associated with higher mortality. Mortality was not affected by use of surgical therapy or choice of antifungal agent. A subgroup analysis was performed on 33 patients for whom specific antifungal therapy information was available. In this subgroup, 11 patients received amphotericin B-based therapy and 14 received echinocandin-based therapy. Despite a higher percentage of older patients and nosocomial infection in the echinocandin group, mortality rates were similar between the two groups. In conclusion, Candida infective endocarditis is associated with a high mortality rate that was not impacted by choice of antifungal therapy or by adjunctive surgical intervention. Additionally, echinocandin therapy was as effective as amphotericin B-based therapy in the small subgroup analysis.
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18
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Hatipoglu N, Hatipoglu H. Combination antifungal therapy for invasive fungal infections in children and adults. Expert Rev Anti Infect Ther 2014; 11:523-35. [DOI: 10.1586/eri.13.29] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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19
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Gardiner BJ, Slavin MA, Korman TM, Stuart RL. Hampered by historical paradigms - echinocandins and the treatment ofCandidaendocarditis. Mycoses 2013; 57:316-9. [DOI: 10.1111/myc.12154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/15/2013] [Accepted: 10/17/2013] [Indexed: 11/30/2022]
Affiliation(s)
- B. J. Gardiner
- Monash Infectious Diseases; Monash Medical Centre; Clayton Vic. Australia
| | - M. A. Slavin
- Peter MacCallum Cancer Centre and Faculty of Medicine; University of Melbourne; Melbourne Vic. Australia
| | - T. M. Korman
- Monash Infectious Diseases; Monash Medical Centre; Clayton Vic. Australia
- Department of Medicine; Monash University; Clayton Vic. Australia
| | - R. L. Stuart
- Monash Infectious Diseases; Monash Medical Centre; Clayton Vic. Australia
- Department of Medicine; Monash University; Clayton Vic. Australia
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20
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21
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Wallner M, Steyer G, Krause R, Gstettner C, von Lewinski D. Fungal endocarditis of a bioprosthetic aortic valve. Herz 2012; 38:431-4. [DOI: 10.1007/s00059-012-3715-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 10/09/2012] [Accepted: 10/11/2012] [Indexed: 11/28/2022]
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22
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Htwe TH, Khardori NM. Cardiac emergencies: infective endocarditis, pericarditis, and myocarditis. Med Clin North Am 2012; 96:1149-69. [PMID: 23102482 DOI: 10.1016/j.mcna.2012.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cardiac infections presenting as emergencies include complications of infective endocarditis, including congestive heart failure, chordae tendinae rupture, cardiac arrhythmias, and embolic phenomenon; acute pericarditis, including cardiac tamponade; and acute myocarditis presenting with malignant cardiac arrhythmias or congestive heart failure. Most of these emergent infectious disease manifestations of the cardiovascular system have a good prognosis if diagnosed early and managed appropriately. Newer diagnostic modalities and combined treatment guidelines are available from the European Society of Cardiology and the American Heart Association.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Sentara Medical Group, Norfolk, VA 23502-3979, USA
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23
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Kang SJ, Jang MO, Jang HC, Jung SI, Shin JH, Park KH. A Case of Candida pelliculosaProsthetic Valve Endocarditis Treated with Anidulafungin and Valve Replacement. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ok Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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24
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Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, Höhl R, Horré R, Karthaus M, Kujath P, Willinger B, Presterl E, Rath P, Ritter J, Glasmacher A, Lass-Flörl C, Groll AH. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54:279-310. [PMID: 21672038 DOI: 10.1111/j.1439-0507.2011.02040.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
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Affiliation(s)
- Markus Ruhnke
- Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
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Abstract
Infective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease--mostly chronic rheumatic heart disease--IE now tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices, and patients exposed to healthcare-associated bacteremia. As a result, skin organisms (for example, Staphylococcus spp.) are now reported as the pathogen in these populations more often than oral streptococci, which still prevail in the community and in native-valve IE. Moreover, progress in molecular diagnostics has helped to improve the diagnosis of poorly cultivable pathogens, such as Bartonella spp. and Tropheryma whipplei, which are responsible for blood-culture-negative IE more often than expected. Epidemiological data indicate that IE mostly occurs independently of medico-surgical procedures, and that circumstantial antibiotic prophylaxis is likely to protect only a minute proportion of individuals at risk. Therefore, new strategies to prevent IE--including improvement of dental hygiene, decontamination of carriers of Staphylococcus aureus, vaccination, and, possibly, antiplatelet therapy--must be explored.
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27
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Durante-Mangoni E, Tripodi MF, Albisinni R, Utili R. Management of Gram-negative and fungal endocarditis. Int J Antimicrob Agents 2010; 36 Suppl 2:S40-5. [PMID: 21129927 DOI: 10.1016/j.ijantimicag.2010.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Infective endocarditis is infrequently caused by Gram-negative bacteria or fungi. Gram-negative organisms are responsible for <4% of cases, whilst fungal endocarditis accounts for <1.5% of culture-positive cases worldwide. Endocarditis due to Gram-negative organisms or fungi is a rare but severe disease. It often has a nosocomial origin, is caused by virulent and often resistant organisms and presents a high rate of complications and high mortality. In this article we present the most recent literature data and address the current management of Gram-negative and fungal infective endocarditis. We also discuss the major challenges of antimicrobial treatment and discuss some issues related to surgical decision-making in difficult-to-manage cases. We finally present our centre's experience with Gram-negative infective endocarditis, with a special focus on the demanding issues that the management of these complex and severely ill patients raise.
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28
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Balasingham S, Chalkias S, Balasingham A, Saul Z, Wickes BL, Sutton DA. A case of bovine valve endocarditis caused by Engyodontium album. Med Mycol 2010; 49:430-4. [PMID: 21108570 DOI: 10.3109/13693786.2010.538444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report the first case of Engyodontium album bioprosthetic valve endocarditis in a 44-year-old male with a history of juvenile rheumatoid arthritis. There is only one other report of Engyodontium album as a human pathogen. The present case supports the increased incidence of fungal endocarditis especially in patients receiving immunotherapy.
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Affiliation(s)
- Shiva Balasingham
- Bridgeport Hospital/Yale University Internal Medicine Program, Bridgeport, Connecticut 06604, USA.
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29
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Ramage G, Mowat E, Jones B, Williams C, Lopez-Ribot J. Our current understanding of fungal biofilms. Crit Rev Microbiol 2010; 35:340-55. [PMID: 19863383 DOI: 10.3109/10408410903241436] [Citation(s) in RCA: 326] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Fungal biofilms are an escalating clinical problem associated with significant rates of mortality. Candida albicans is the most notorious of all fungal biofilm formers. However, non-Candida species, yeasts such as Cryptococcus neoformans, and filamentous moulds such as Aspergillus fumigatus, have been shown to be implicated in biofilm-associated infections. Fungal biofilms have distinct developmental phases, including adhesion, colonisation, maturation and dispersal, which are governed by complex molecular events. Recalcitrance to antifungal therapy remains the greatest threat to patients with fungal biofilms. This review discusses our current understanding of the basic biology and clinical implications associated with fungal biofilms.
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Affiliation(s)
- Gordon Ramage
- Section of Infection and Immunity, Glasgow Dental School and Hospital, Faculty of Medicine, University of Glasgow, UK.
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30
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Tratamiento conservador en un caso de endocarditis protésica candidiásica con los nuevos antifúngicos. Enferm Infecc Microbiol Clin 2010; 28:66-7. [DOI: 10.1016/j.eimc.2009.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 01/28/2009] [Accepted: 02/02/2009] [Indexed: 11/18/2022]
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31
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1230] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
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Espinel-Ingroff A, Canton E, Martin-Mazuelos E, Pemán J. Pharmacotherapy of Candida Infections with Echinocandins. ACTA ACUST UNITED AC 2009. [DOI: 10.4137/cmt.s2311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The classic recommended antifungal agents for the treatment of invasive Candida infections were amphotericin B, a lipid formulation of amphotericin B and fluconazole in both neutropenic or nonneutropenic patients as either primary or alternative therapies. Voriconazole has been recommended when additional coverage for filamentous fungi is needed (e.g. neutropenic patients). More recently and based on well designed comparative clinical trials, the three echinocandins, caspofungin, anidulafungin and micafungin have been added as primary or alternative therapies especially for critically ill or neutropenic patients. In general, the echinocandins are most useful when patients have previously been exposed to an azole or are unstable.
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Affiliation(s)
| | - Emilia Canton
- Unidad de Microbiología Experimental, Centro de investigación, Hospital Universitario La Fe, valencia, Spain
| | | | - Javier Pemán
- Servicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain
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Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, Rizzi M, Suter F, Utili R, Viscoli C, Venditti M. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine (Baltimore) 2009; 88:160-168. [PMID: 19440119 DOI: 10.1097/md.0b013e3181a693f8] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Candida species are an uncommon cause of infective endocarditis (IE). Given the rarity of this infection, the epidemiology, prognosis, and optimal therapy of Candida IE are poorly defined. We conducted a prospective, observational study at 18 medical centers in Italy, including all consecutive patients with a definite diagnosis of IE admitted from January 2004 through December 2007.A Candida species was the causative organism in 8 cases of prosthetic valve endocarditis (PVE), 5 cases of native valve endocarditis (NVE), 1 case of pacemaker endocarditis, and 1 case of left ventricular patch infection. Candida species accounted for 1.8% of total cases, and for 3.4% of PVE cases. Most patients (86.6%) had a health care-associated infection. PVE associated with a health care contact occurred after a median of 225 days from valve implantation. Ten patients (66.6%) were treated with caspofungin alone or in combination with other antifungal drugs. The overall mortality rate was 46.6%. Mortality was higher in patients with PVE (5 of 8 cases, 62.5%) than in patients with NVE (2 of 5 patients, 40%). A better outcome was observed in patients treated with a combined medical and surgical therapy.Candida IE should be classified as an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial related morbidity and mortality. Candida PVE usually is a late-onset disease, which becomes clinically evident even several months after an initial episode of transient candidemia.
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Affiliation(s)
- Marco Falcone
- From Dipartimento di Medicina Clinica (MF, MV), Policlinico Umberto I, Università degli Studi di Roma "La Sapienza," Rome; UO Terapia Intensiva Cardiochirurgica (NB), ASO S. Croce e Carle, Cuneo; Malattie Infettive e Tropicali (GC), Università degli Studi di Brescia, Brescia; Malattie Infettive e Tropicali (PG), Università degli Studi dell'Insubria, Varese; Malattie Infettive (LM), IRCCS San Matteo, Pavia; Malattie Infettive (VR, MR, FS), Ospedali Riuniti di Bergamo, Bergamo; Medicina Infettivologica e dei Trapianti (RU), Azienda Ospedaliera Monaldi, Napoli; Clinica Malattie Infettive (CV), Università di Genova, Genova, Italy
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Block AA, Thursky KA, Worth LJ, Slavin MA. Thrombolytic therapy for management of complicated catheter-relatedCandida albicansthrombophlebitis. Intern Med J 2009; 39:61-3. [DOI: 10.1111/j.1445-5994.2008.01867.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:503-35. [PMID: 19191635 PMCID: PMC7294538 DOI: 10.1086/596757] [Citation(s) in RCA: 2011] [Impact Index Per Article: 134.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
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Affiliation(s)
- Peter G Pappas
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA.
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Baddley JW, Benjamin DK, Patel M, Miró J, Athan E, Barsic B, Bouza E, Clara L, Elliott T, Kanafani Z, Klein J, Lerakis S, Levine D, Spelman D, Rubinstein E, Tornos P, Morris AJ, Pappas P, Fowler VG, Chu VH, Cabell C. Candida infective endocarditis. Eur J Clin Microbiol Infect Dis 2008; 27:519-29. [PMID: 18283504 DOI: 10.1007/s10096-008-0466-x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 01/16/2008] [Indexed: 12/25/2022]
Abstract
Candida infective endocarditis (IE) is uncommon but often fatal. Most epidemiologic data are derived from small case series or case reports. This study was conducted to explore the epidemiology, treatment patterns, and outcomes of patients with Candida IE. We compared 33 Candida IE cases to 2,716 patients with non-fungal IE in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS). Patients were enrolled and the data collected from June 2000 until August 2005. We noted that patients with Candida IE were more likely to have prosthetic valves (p < 0.001), short-term indwelling catheters (p < 0.0001), and have healthcare-associated infections (p < 0.001). The reasons for surgery differed between the two groups: myocardial abscess (46.7% vs. 22.2%, p = 0.026) and persistent positive blood cultures (33.3% vs. 9.9%, p = 0.003) were more common among those with Candida IE. Mortality at discharge was higher in patients with Candida IE (30.3%) when compared to non-fungal cases (17%, p = 0.046). Among Candida patients, mortality was similar in patients who received combination surgical and antifungal therapy versus antifungal therapy alone (33.3% vs. 27.8%, p = 0.26). New antifungal drugs, particularly echinocandins, were used frequently. These multi-center data suggest distinct epidemiologic features of Candida IE when compared to non-fungal cases. Indications for surgical intervention are different and mortality is increased. Newer antifungal treatment options are increasingly used. Large, multi-center studies are needed to help better define Candida IE.
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Affiliation(s)
- J W Baddley
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0006, USA.
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Abstract
Pericarditis due to Candida species is a rare clinical entity, associated with thoracic surgery and immunosuppression. We report here the second case of pericarditis due to Candida albicans in a heart transplant patient, which presented as tamponade approximately 3 weeks post transplant, in the absence of evidence of sternal osteomyelitis. The patient was treated with pericardiocentesis and a combination of caspofungin and fluconazole, but the patient ultimately required the explantation of retained epicardial leads and the creation of a pericardial window. This case illustrates that Candida species must be considered in the differential diagnosis in post-transplant pericarditis, and that foreign body removal is, as always, key in helping to resolve such infections. This case also demonstrates the first use of caspofungin with fluconazole to treat Candida pericarditis. We discuss the conflicting data regarding the use of caspofungin, alone or in combination therapy, in treating infections involving biofilms, such as the infected pericardium.
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Affiliation(s)
- Y A Puius
- Department of Medicine, Division of Infectious Diseases, Columbia University Medical Center, New York, New York 10032, USA
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41
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Abstract
Caspofungin was the first echinocandin to be licensed for the treatment of invasive fungal infections. Caspofungin has in vitro and in vivo activity against Candida spp. and Aspergillus spp., which constitute the majority of medically important opportunistic fungal pathogens. Caspofungin inhibits the synthesis of the 1,3-beta-glucan, with resultant osmotic instability and lysis. The pharmacology of caspofungin is relatively complex. Trafficking of drug into tissues is an important determinant of the shape of the concentration-time relationship. Caspofungin has demonstrated efficacy in experimental models of invasive candidiasis and aspergillosis, which reflect its activity in the treatment of oropharyngeal, esophageal and disseminated candidiasis, as well as salvage therapy for patients with invasive aspergillosis.
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Affiliation(s)
- William W Hope
- National Institutes of Health, 10 Center Dr, Bethesda, MD, 20892, USA
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42
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Abstract
Infective endocarditis (IE) is estimated to have an incidence of five to seven cases per 100,000 person-years. Although not a common clinical entity, IE is associated with substantial morbidity and risk of mortality. IE, especially infections due to Staphylococcus aureus, are increasingly healthcare-associated infections. Despite significant advances in diagnosis and management, mortality from IE has changed little since the availability of penicillin; however, this lack of improvement in mortality is likely due to an increasing number of infections from more virulent and drug-resistant pathogens coupled with infections that occur in patients with other comorbidities and those associated with prosthetic valves. Surgery is an important part of therapy for many patients, but surprisingly, little evidence is available to help clinicians determine which patients will benefit most from surgical therapy for the management of IE.
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Affiliation(s)
- Patricia D Brown
- Wayne State University School of Medicine, Detroit Receiving Hospital, 5S, 4201 St. Antoine, Detroit, MI 48201, USA.
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Schelenz S, Ross CN. Limitations of caspofungin in the treatment of obstructive pyonephrosis due to Candida glabrata infection. BMC Infect Dis 2006; 6:126. [PMID: 16895593 PMCID: PMC1560384 DOI: 10.1186/1471-2334-6-126] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 08/08/2006] [Indexed: 11/17/2022] Open
Abstract
Background Caspofungin is a new antifungal agent with high-level activity against a number of Candida species including those that are resistant to azoles. Its good safety profile and low nephrotoxicity makes it an attractive drug to treat fungal infections in patients with compromised renal function. However, little is known about the clinical efficacy in the treatment of complicated urinary tract infections due to Candida species such as pyonephrosis. Case presentation We report a case of obstructive pyonephrosis due to an azole (fluconazole and itraconazole) resistant Candida glabrata strain that failed to respond to intravenous treatment with caspofungin. A sustained clinical and microbiological response was only achieved after percutaneous drainage and instillation of amphotericin B deoxycholate into the renal pelvis in combination with intravenous liposomal amphotericin B. Conclusion This case demonstrates the limitation of intravenous antifungal agents such as caspofungin as the sole treatment of an obstructive upper urinary tract infection due to Candida species. In order to achieve long term sustained cure from an obstructive pyonephrosis, pus and fungal balls should be drained and an anti-fungal agent such as amphotericin B deoxycholate instilled locally. The pharmacokinetics and role of caspofungin in the treatment of complicated Candida urinary tract infection is reviewed.
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Affiliation(s)
- Silke Schelenz
- Microbiology Department, Norfolk and Norwich University Hospital, UK
| | - Calum N Ross
- Department of Renal Medicine, Norfolk and Norwich University Hospital, UK
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López-Ciudad V, Castro-Orjales MJ, León C, Sanz-Rodríguez C, de la Torre-Fernández MJ, de Juan-Romero MAP, Collell-Llach MD, Díaz-López MD. Successful treatment of Candida parapsilosis mural endocarditis with combined caspofungin and voriconazole. BMC Infect Dis 2006; 6:73. [PMID: 16608509 PMCID: PMC1458348 DOI: 10.1186/1471-2334-6-73] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2005] [Accepted: 04/11/2006] [Indexed: 11/23/2022] Open
Abstract
Background Fungal mural endocarditis is a rare entity in which the antemortem diagnosis is seldom made. Seven cases of mural endocarditis caused by Candida spp. have been collected from literature and six of these patients died after treatment with amphotericin B. Case presentation We report a case of mural endocarditis diagnosed by transesophageal echocardiogram and positive blood cultures to Candida parapsilosis. Because blood cultures continued to yield C. parapsilosis despite caspofungin monotherapy, treatment with voriconazole was added. Conclusion This is the first description of successful treatment of C. parapsilosis mural endocarditis with caspofungin and voriconazole.
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Affiliation(s)
- Víctor López-Ciudad
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María J Castro-Orjales
- Intensive Care Unit, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - Cristóbal León
- Intensive Care Unit and Emergency Service, Hospital Universitario de Valme, Sevilla, Spain
| | - César Sanz-Rodríguez
- Department of Clinical Research, Merck Sharp & Dohme de España, S.A. Madrid, Spain
| | | | | | - María D Collell-Llach
- Department of Cardiology, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
| | - María D Díaz-López
- Unit of Infectious Diseases, Hospital Santa María Madre-Complejo Hospitalario de Ourense, Ourense, Spain
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