Incidence and Predictors of Candida Endocarditis in Hospitalized Patients With Candidemia: Insights From the National Inpatient Sample (2016 to 2022).

Candida endocarditis (CE) is a rare but life-threatening complication of candidemia, often requiring prolonged antifungal therapy or surgical intervention. With the rising prevalence of non-albicans Candida species and evolving risk factors, understanding the contemporary risk profile for CE is critical for timely diagnosis and management. We conducted a retrospective cohort study using National Inpatient Sample (NIS) data from 2016 to 2022 to identify adult hospitalizations with candidemia and Candida endocarditis using ICD-10-CM codes. Patient demographics and clinical characteristics were assessed. Unadjusted and multivariable logistic regression analyses were performed to identify independent predictors of CE. Among 87,839 hospitalized patients with candidemia, 1,280 (1.5%) were diagnosed with CE. Patients with CE were younger, more likely to have a history of IV drug use, prosthetic valves, pacemaker/ICD, and be undergoing dialysis. In multivariable regression analysis, independent predictors of CE included prosthetic valves, IV drug use, pacemaker/ICD, coronary stents, dialysis, and ventricular assist devices. Factors associated with lower odds of CE were older age, diabetes, hematologic or solid organ malignancy, and radiation therapy. CE was associated with longer hospital stays and higher hospitalization costs, but no significant difference in in-hospital mortality. These findings highlight a contemporary risk profile-younger patients with cardiac hardware, dialysis, or IV drug use-underscoring the need for targeted screening and early multidisciplinary management to curb morbidity and resource use.