Endocarditis Is Not Rare and Is an Independent Predictor of Mortality in Candidaemia

BACKGROUND: Candida endocarditis (CE) is a highly fatal manifestation of candidaemia. Currently, screening for CE is not recommended as a routine in patients presented with candidaemia, as CE is considered rare. The objective of this study was to determine the incidence, risk factors and outcome of CE in candidaemia, in order to guide the screening. METHODS: Retrospective chart review of patients with candidaemia from a tertiary center in Australia, admitted between January 2005 and December 2015, was conducted. Clinical characteristics and outcomes of patients with CE and without CE were compared, and logistic regression analyses were performed to identify the risk factors associated with CE and mortality. RESULTS: Eighty-six patients with candidaemia were identified with mean ± SD age of 52 ± 22 years, comprising 51% males. Candida albicans was the most common species (41%). Echocardiogram was performed in 88% of cases. Eleven patients (13%) had CE. Most candidaemia cases were hospital-acquired, but patients with CE were more likely to have community-acquired fungaemia (P < 0.001), dissemination to other organs (P < 0.001), and a cardiac prosthesis (P < 0.05). On logistic regression, community-acquired fungaemia (odds ratio OR: 22.3; P < 0.001) and presence of a cardiac prosthesis (odds ratio OR: 4.0; P < 0.05) were predictors of CE. Overall mortality rates for candidaemia were 14% for 30-day and 16% for 90-day. Mortality was much higher in patients with CE (27% for 30-day and 36% for 90-day), and CE was an independent predictor of candidaemia-related mortality (OR: 6.2; P < 0.05 for 30-day, and OR: 8.3; P < 0.05 for 90-day). CONCLUSION: CE is not rare in candidaemia, and is associated with very high mortality. Low index of suspicion for CE and early investigation with echocardiogram are indicated, especially in patients with cardiac prosthesis or community-acquired candidaemia. DISCLOSURES: All authors: No reported disclosures.