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Candidemia in patients with cardiovascular implantable electronic devices

Abstract

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.

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Funding

This project described was supported by CTSA award No. UL1 TR002243 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

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Correspondence to Jay A. Montgomery.

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The authors declare that they have no conflict of interest.

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Nakamura, T., Narui, R., Holmes, B. et al. Candidemia in patients with cardiovascular implantable electronic devices. J Interv Card Electrophysiol (2020). https://doi.org/10.1007/s10840-020-00706-0

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Keywords

  • Fungemia
  • Cardiovascular implantable electronic devices
  • Lead extraction
  • Candida