# P-1953. Incidence, Clinical Characteristics, and Outcomes of Candida Endocarditis in Patients with Candidemia

## TL;DR

This study examines how often Candida endocarditis occurs in patients with candidemia and identifies risk factors and outcomes.

## Contribution

The study identifies specific risk factors for Candida endocarditis and compares antifungal treatment patterns and outcomes in affected patients.

## Key findings

- Candida endocarditis was rare, occurring in 1.5% of candidemia cases.
- Patients with Candida endocarditis were younger, more likely Hispanic, and had higher rates of prosthetic valves and chronic kidney disease.
- C. albicans was the most common species in both groups, but more prevalent in endocarditis cases.

## Abstract

Candida endocarditis (CE) is a severe complication of candidemia with a poor prognosis. Despite its clinical importance, data on the incidence and risk factors for CE remain limited. This study aimed to characterize patients with CE and identify factors associated with its occurrence.Table.Baseline Characteristics*Antifungals for treatment were identified using RxNorm codes between day 0 and day 14 after diagnosis. Specific informationon different amphotericin B formulations was not available.Figure.Distribution of Candida species isolatedDistribution of Candida species isolated from patients without candida endocarditis (CE) (blue columns) and those with CE (red columns). C. albicans was the most common species in both groups, with a higher proportion among CE cases (55.6% vs. 40.1%). C. auris was identified only in candidemia alone. Other species, including Nakaseomyces glabratus (formerly C. glabrata), Pichia kudriavzevii (formerly C. krusei), C. parapsilosis, C. tropicalis, and multispecies candidemia, were less frequent (p=0.068).

Baseline Characteristics

*Antifungals for treatment were identified using RxNorm codes between day 0 and day 14 after diagnosis. Specific information

on different amphotericin B formulations was not available.

Distribution of Candida species isolated

Distribution of Candida species isolated from patients without candida endocarditis (CE) (blue columns) and those with CE (red columns). C. albicans was the most common species in both groups, with a higher proportion among CE cases (55.6% vs. 40.1%). C. auris was identified only in candidemia alone. Other species, including Nakaseomyces glabratus (formerly C. glabrata), Pichia kudriavzevii (formerly C. krusei), C. parapsilosis, C. tropicalis, and multispecies candidemia, were less frequent (p=0.068).

We performed a retrospective cohort study using TriNetX, a global federated health research network. Adults (≥ 18 years) with candidemia, confirmed by blood PCR testing between May 2017 and November 2023, were included. CE was defined by the presence of ICD-10 code B37.6. Patients were categorized as having candidemia alone or CE. Demographics, comorbidities, Candida species, antifungal therapy, and 1-year mortality were compared between groups.

Of 1234 patients with candidemia, 18 (1.5%) were diagnosed with CE. Patients with CE were younger (mean age 42.3 vs 53.4 years, p=0.023) and more likely to identify as Hispanic (33.3% vs 11%, p=.012) (Table). Prosthetic valves (38.9% vs 2.8%, p< .001), systemic connective tissue disease (22.2% vs 2.5%, p< 0.001), and chronic kidney disease (44.4% vs 22.5%, p=0.027) were significantly more common in CE. C. albicans was the most frequently isolated species in both groups, though more common in CE (55.6% vs 40.1%, p=0.068) (Figure). Patients with CE were more likely to receive an echinocandin (38.9% vs. 23.5%; p=0.128) or amphotericin B (16.7% vs. 2.1%; p< 0.001), while azole antifungal use was similar between groups (50% vs. 29.8%; p=0.063), with fluconazole being the most commonly used azole in both. One year mortality was comparable between groups (27.8% for CE vs. 27.5% for candidemia alone; p=0.976).

In this large candidemia cohort, CE was rare but associated with identifiable risk factors, including prosthetic heart valves, systemic connective tissue disease, and chronic kidney disease. Although C. albicans was more frequently isolated in CE cases, overall, Candida species distribution was similar. Despite differences in clinical characteristics and antifungal therapy, 1-year mortality did not differ between patients with and without CE.

Andrés F. Henao Martínez, MD, MPH, F2: Grant/Research Support|Scynexis: Grant/Research Support