Objective: To explore the clinical characteristics, treatment regimens and outcomes of the patients with fungal infective endocarditis.
Methods: An observational study was conducted at our hospital and recruited 22 consecutive patients with a definite diagnosis of fungal infective endocarditis. Their overall characteristics, treatments, complications and outcomes were analyzed.
Results: The mean age at presentation was 45 years with a slight male preponderance. Among them, 13 cases had healthcare-associated infective endocarditis and 1 patient was an intravenous drug user. Aortic valve (40.9%) was most commonly affected and it was followed by mitral valve (13.6%). The most common etiological agent was Candida (68.2%), followed by Aspergillus (22.7%). Risk factors include the prosthetic valve replacement surgery, impaired immune function, and so on. Major complications during the acute infective phase were also recorded, including heart failure, embolic events, uncontrolled infections and renal dysfunction. The overall hospital mortality rate was 40.9%. There were 15 patients with antifungal treatment, which including fluconazole, itraconazole, caspofungin acetate and voriconazole itraconazole. The remaining 7 patients (31.8%) underwent valve replacement surgery, including 3 cases of cardiac valve re-replacement. A better outcome was observed in patients on a combined regimen of medical and surgical therapies.
Conclusions: Fungal endocarditis is associated with more invasive interventions and immunocompromised patients. The incidence of embolic events and in-hospital mortality is still high in patients with fungal endocarditis, and the larger vegetation is more common. Heart failure, sepsis and repeated arterial embolization are the most common cause of death.