Candidemia in patients with cardiovascular implantable electronic devices

• Published in: Journal of interventional cardiac electrophysiology Vol. 60; no. 1; pp. 69 - 75
• Main Authors: Nakamura, Tomofumi, Narui, Ryohsuke, Holmes, Benjamin, Norton, Caleb, Kim, Eun-jeong, Nakajima, Ikutaro, Stevenson, William G., Greene, Matthew H., John, Roy M., Ellis, Christopher R., Crossley, George H., Montgomery, Jay A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 2021; Springer Nature B.V
• Subjects: Antiinfectives and antibacterials; Candidemia; Cardiology; Catheters; Complications; Drug abuse; Echocardiography; Electronic devices; Electronic equipment; Fungemia; Hemodialysis; Infections; Intravenous administration; Lead; Medical instruments; Medicine; Medicine & Public Health; Sepsis; Vegetation; Fungemia; Cardiovascular implantable electronic devices; Lead extraction; Candida
• ISSN: 1383-875X; 1572-8595
• DOI: 10.1007/s10840-020-00706-0

Purpose
Current guidelines recommend complete extraction of cardiovascular implantable electronic devices (CIEDs) in the case of persistent or recurrent fungemia without other identifiable sources, though supporting evidence is lacking. We sought to evaluate the prognosis of patients with candidemia and CIEDs.
Methods
Twelve consecutive patients (54 ± 12 years, 8 male) with CIED and concurrent candidemia were reviewed.
Results
At the time of diagnosis with candidemia, seven patients were immunocompromised, six were on long-term antibacterial therapy, two were intravenous drug users, four were on chronic hemodialysis, and six had a central venous catheter. Four patients were confirmed as definite CIED infection as vegetation was visible on lead by echocardiogram. The other 8 patients were considered possible CIED infection with candidemia of unknown focus. All patients with visible vegetation underwent CIED removal without complications, and other patients were initially managed non-operatively. After 1 year of follow-up, 7 patients had died and at extended follow-up, all patients without lead removal died while 3 of 4 patients with lead extraction survived. Of note, 50% of deaths in the patients without lead removal were associated with fungal sepsis.
Conclusions
Candida fungemia is associated with a high mortality. CIED removal should be an early consideration in these patients even if lead vegetations are not seen.