The Frequency of Infective Endocarditis in Candida Bloodstream Infections: a Retrospective Study in a Child Hospital

Abstract Introduction: Fungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis. Objective: In this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed. Methods: Patients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined. Results: 221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them. Conclusion: Although Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

引言：真菌性心内膜炎的报道例数少于细菌性心内膜炎，在儿童感染性心内膜炎总病例中占比为0%~12%。目的：本研究回顾了2007年至2016年间某三级医院内念珠菌血流感染患者的感染性心内膜炎发病情况。方法：对2007年1月至2016年1月研究期间，血液或导管培养念珠菌属（Candida spp.）结果呈阳性的患者，针对念珠菌感染性心内膜炎展开分析。感染性心内膜炎的诊断依据改良杜克标准（modified Duke criteria）。本研究对患者的预后情况，以及念珠菌性心内膜炎可能的相关易感因素进行了统计分析。结果：本研究共纳入221例患者，共计256次血液或导管念珠菌培养阳性的发作事件。最常见的念珠菌菌种为近平滑念珠菌（Candida parapsilosis），在157次（61.3%）发作事件中分离得到；其次为白念珠菌（Candida albicans），占70次（27.3%）。常见合并症包括神经系统疾病（23%）、血液肿瘤性疾病（12.1%）、既往已知心脏疾病（8.2%）、先天性代谢异常（9%）。12例（5.4%）患者有心脏手术史。在221例患者中，仅2例（0.9%）发生念珠菌性心内膜炎。结论：尽管念珠菌感染性心内膜炎在儿童群体中虽不常见但往往致命，对于血液或导管培养念珠菌阳性的患者，应常规开展超声心动图检查。及时有效的抗菌治疗可在部分病例中避免心脏手术，但这并非适用于所有患者的通用原则。