%0 Journal Article %T Diagnosis, management and outcome of Candida endocarditis %+ Service des Maladies infectieuses et tropicales [CHU Necker] %+ Institut Pasteur [Paris] (IP) %+ Université Lille Nord (France) %+ Université Paris Diderot - Paris 7 (UPD7) %+ AP-HP - Hôpital Bichat - Claude Bernard [Paris] %+ Université Paris Descartes - Paris 5 (UPD5) %+ Université Pierre et Marie Curie - Paris 6 (UPMC) %+ Centre de Recherche des Cordeliers (CRC (UMR_S 872)) %+ Hôpital Européen Georges Pompidou [APHP] (HEGP) %+ Centre National de Référence des Mycoses invasives et antifongiques - Mycologie moléculaire (CNRMA) %+ Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology %+ Hôpital Henri Mondor %A Lefort, A %A Chartier, L. %A Sendid, B %A Wolff, M. %A Mainardi, Jl %A Podglajen, I. %A Desnos-Ollivier, M %A Fontanet, A. %A Bretagne, S. %A Lortholary, O. %Z This study received grants from Pfizer and Merck Sharp & Dohme-Chibret, France. The sponsors had no role in designing or conducting the study, the collection, management, analysis and interpretation of the data, or the preparation, review or approval of the manuscript. Financial disclosure: O. Lortholary has received research grants from Pfizer and Gilead Sciences, is a consultant for Gilead Sciencesand Astellas, and is a member of the speaker’s bureaus of Pfizer, Merck, Astellas, Gilead Sciences, and Schering Plough.J. L. Mainardi has received a research grant from Novartis. S. Bretagne is a consultant for Gilead Sciences, and hasreceived speaking honoraria from Pfizer and Gilead Sciences and travel grants from Astellas, Pfizer, and Schering-Plough.M. Wolff has received consulting and lecture fees from Astellas, Gilead, Janssen-Cilag, and Aventis. %< avec comité de lecture %@ 1198-743X %J Clinical Microbiology and Infection %I Elsevier for the European Society of Clinical Microbiology and Infectious Diseases %V 18 %N 4 %P E99-E109 %8 2012-04 %D 2012 %R 10.1111/j.1469-0691.2012.03764.x %M 22329526 %K molecular tools %K Candida %K endocarditis %K antibody detection %K antigen detection %Z Life Sciences [q-bio]/Microbiology and Parasitology/MycologyJournal articles %X Limited data exist on Candida endocarditis (CE) outcome in the era of new antifungals. As early diagnosis of CE remains difficult, non-culture-based tools need to be evaluated. Through the French prospective MYCENDO study (2005-2007), the overall characteristics and risk factors for death from CE were analysed. The contribution of antigen detection (mannan/anti-mannan antibodies and (1,3)-β-d-glucans) and molecular tools was evaluated. Among 30 CE cases, 19 were caused by non-albicans species. Sixteen patients (53%) had a predisposing cardiac disease, which was a valvular prosthesis in ten (33%). Nine patients (30%) were intravenous drug users; none of them had right-sided CE. Among the 21 patients who were not intravenous drug users, 18 (86%) had healthcare-associated CE. Initial therapy consisted of a combination of antifungals in 12 of 30 patients (40%). Thirteen patients (43%) underwent valve replacement. The median follow-up was 1 year after discharge from hospital (range, 5 months to 4 years) and hospital mortality was 37%. On univariate analysis, patients aged ≥60 years had a higher mortality risk (OR 11, 95% CI 1.2-103.9; p 0.024), whereas intravenous drug use was associated with a lower risk of death (OR 0.12, 95% CI 0.02-0.7; p 0.03). Among 18 patients screened for both serum mannan/anti-mannan antibodies and (1,3)-β-d-glucans, all had a positive result with at least one of either test at CE diagnosis. Real-time PCR was performed on blood (SeptiFast) in 12 of 18, and this confirmed the blood culture results. In conclusion, CE prognosis remains poor, with a better outcome among younger patients and intravenous drug users. Detection of serum antigens and molecular tools may contribute to earlier CE diagnosis. %G English %Z The authors thank the Direction Médicale de l'Institut Pasteur, Paris, for having promoted the study, and A. Desjardins for her careful review of the manuscript. O. Lortholary had full access to all of the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. %L pasteur-02194882 %U https://pasteur.hal.science/pasteur-02194882 %~ INSERM %~ PASTEUR %~ UNIV-PARIS5 %~ UNIV-PARIS7 %~ UPMC %~ CNRS %~ CNAM %~ APHP %~ UPEC %~ CORDELIERS %~ UPMC_POLE_4 %~ CHU-UNIV-PARIS5 %~ SORBONNE-UNIVERSITE %~ SU-SCIENCES %~ UNIV-PARIS %~ SU-TI %~ ALLIANCE-SU %~ TEST3-HALCNRS %~ HESAM-CNAM %~ HESAM %~ PASTEUR_UMR2000 %~ CNRMA %~ MYCO-MOL-CNRMA