Kurland Siri, Furebring Mia, Löwdin Elisabeth, Olaison Lars, Sjölin Jan
Department of Medical Sciences, Infection Medicine, Uppsala University, Uppsala, Sweden.
Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Clin Infect Dis. 2025 Jun 14. doi: 10.1093/cid/ciaf312.
Amphotericin B-based treatment has been the cornerstone of Candida infective endocarditis (CIE) treatment, but recent guidelines also recommend echinocandins. However, there is limited outcome data. The few studies performed report differing results. The aim of this study was to compare the outcome with echinocandins to other antifungal strategies.
A CIE cohort was derived from the Swedish Registry of Infective Endocarditis for 1995-2019. In-hospital mortality or relapse was considered treatment failure.
A total of 51 episodes were treated with echinocandins (n=21), amphotericin-B-based therapy (n=22), or azoles (n=8). The proportions of treatment failure were 32%, 38%, and 62%, respectively (p=0.35). Patients receiving echinocandins were older and had a higher burden of comorbidities. The overall one-year mortality rate from index hospitalization was 26%, with no significant differences between backbone therapies (p=0.18). As C. parapsilosis IE was not treated with echinocandins, a subgroup analysis was performed of 33 episodes with C. non-parapsilosis showing no significant differences between backbone therapies (p=0.33). In a subgroup analysis of episodes treated with amphotericin B-based therapy, treatment failure was seen in 54% of 13 episodes caused by C. parapsilosis and 12% of 8 episodes caused by C. non-parapsilosis (p=0.10).
No differences in in-hospital mortality, relapse rate, or one-year mortality were seen in patients with echinocandin-based therapy compared with other CIE regimens, including amphotericin B. This despite risk factors in the echinocandin group that would be expected to negatively bias outcome. C. parapsilosis CIE appears to pose specific challenges in terms of optimal therapy.
基于两性霉素B的治疗一直是念珠菌感染性心内膜炎（CIE）治疗的基石，但最近的指南也推荐棘白菌素类药物。然而，关于治疗结果的数据有限。已开展的少数研究报告了不同的结果。本研究的目的是比较棘白菌素类药物与其他抗真菌策略的治疗结果。
CIE队列来自瑞典感染性心内膜炎登记处1995 - 2019年的数据。住院死亡率或复发被视为治疗失败。
共有51例患者分别接受了棘白菌素类药物治疗（n = 21）、基于两性霉素B的治疗（n = 22）或唑类药物治疗（n = 8）。治疗失败的比例分别为32%、38%和62%（p = 0.35）。接受棘白菌素类药物治疗的患者年龄较大，合并症负担较重。首次住院后的总体一年死亡率为26%，主要治疗方法之间无显著差异（p = 0.18）。由于近平滑念珠菌性心内膜炎未采用棘白菌素类药物治疗，因此对33例非近平滑念珠菌性心内膜炎进行了亚组分析，结果显示主要治疗方法之间无显著差异（p = 0.33）。在基于两性霉素B治疗的亚组分析中，13例由近平滑念珠菌引起的病例中有54%治疗失败，8例由非近平滑念珠菌引起的病例中有12%治疗失败（p = 0.10）。
与包括两性霉素B在内的其他CIE治疗方案相比，接受基于棘白菌素类药物治疗的患者在住院死亡率、复发率或一年死亡率方面没有差异。尽管棘白菌素类药物治疗组存在一些危险因素，预计会对治疗结果产生负面影响。近平滑念珠菌性心内膜炎在最佳治疗方面似乎面临特殊挑战。
