Infection. 2026 Mar 5. doi: 10.1007/s15010-026-02757-3. Online ahead of print.
ABSTRACT
BACKGROUND: Candida endocarditis (CE) is a rare but highly lethal complication of candidemia, comprising 1-2% of infective endocarditis cases, yet associated with disproportionately high mortality. Large-scale contemporary data on predictors of in-hospital death remain limited.
METHODS: We conducted a retrospective cohort study using the National Inpatient Sample (2016-2022) to identify adult CE hospitalizations. Weighted descriptive statistics described the cohort, and multivariable logistic regression identified predictors of in-hospital mortality. Secondary outcomes included length of stay (LOS) and hospitalization costs.
RESULTS: Among 1280 CE hospitalizations, in-hospital mortality was 18.8%. Predictors of higher mortality included age 45-64 years (aOR 2.61; 95% CI 1.57-4.41) and ≥ 75 years (aOR 2.11; 95% CI 1.06-4.19), hematologic malignancy (aOR 33.5; 95% CI 12.3-101), surgical ventricular assist devices (aOR 45.7; 95% CI 8.25-284), femoral (aOR 12.9; 95% CI 4.78-36.0) or subclavian (aOR 22.4; 95% CI 5.65-82.7) central venous catheters, septic shock (aOR 9.47; 95% CI 6.21-14.8), embolic stroke (aOR 10.5; 95% CI 4.72-23.9), cardiogenic shock (aOR 3.69; 95% CI 1.61-8.51), and acute kidney injury (aOR 1.64; 95% CI 1.04-2.60). Valve intervention significantly reduced mortality (aOR 0.04; 95% CI 0.01-0.09). Non-survivors had longer hospital stays (median 24 vs. 19 days) and nearly double the hospitalization costs ($117,808 vs. $61,178).
CONCLUSIONS: In this nationally representative cohort, CE remained highly lethal, with age, malignancy, invasive devices, and critical complications driving mortality. Valve intervention conferred substantial survival benefit, underscoring the importance of early recognition, multidisciplinary care, and timely surgical evaluation.
PMID:41784858 | DOI:10.1007/s15010-026-02757-3
