INCIDENCE AND RISK OF DEVELOPING FUNGAL PROSTHETIC VALVE ENDOCARDITISAFTER NOSOCOMIAL CANDIDEMIA

PURPOSE: TO determine the incidence of prosthetic valve endocarditis ( PVE) in fungemic patients with prosthetic heart valves (PHV), estimate the risk of subsequent PVE, and describe risk factors and diagnostic and therapeutic management issues in such patients. PATIENTS AND METHO DS: This is a retrospective chart review in a 1,100-bed tertiary refer ral center with an active cardiothoracic surgical service, Forty-four patients with PHVs developed nosocomial fungemia between January 1985 and April 1995. RESULTS: Of 44 patients, 33 never developed evidence o f PVE (group 1), 7 (16%) had evidence of PVE at the time of candidemia (group 2), and 4 (9%) developed PVE a mean of 232 days after candidem ia (group 3), Predisposing factors including intravascular lines, prio r antibiotic therapy, and an identifiable portal of entry for fungemia were common in group 1 but not group 2, Candidemia occurred significa ntly later after PHV surgery in group 2 (mean 270 days) as compared to groups 1 and 3 (means 48 and 15.5 days, respectively; P = 0.02), Ten of 11 patients with Candida PVE (group 2 and 3) were treated with amph otericin B and valve replacement. Three relapses after combined therap y were documented in two patients, Mortality was significantly higher for patients without Candida PVE (group 1) as compared to patients wit h Candida PVE (groups 2 and 3) at 1 month (53% vs 9%), 2 months (69% v s 20%) and 1 year (83% vs 25%) after candidemia. CONCLUSIONS: Patients with prosthetic heart valves who develop nosocomial candidemia are at notable risk of either having or developing Candida PVE months or yea rs later, Late onset candidemia and lack of an identifiable portal of entry should heighten concern about Candida PVE in such patients. (C) 1997 by Excerpta Medica, Inc.