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.
Twelve consecutive patients (54 ± 12 years, 8 male) with CIED and concurrent candidemia were reviewed.
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.
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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Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, et al. 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol. 2011;58:1001–6.
Bongiorni MG, Tascini C, Tagliaferri E, Di Cori A, Soldati E, Leonildi A, et al. Microbiology of cardiac implantable electronic device infections. Europace. 2012;14:1334–9.
Hussein AA, Baghdy Y, Wazni OM, Brunner MP, Kabbach G, Shao M, et al. Microbiology of cardiac implantable electronic device infections. J Am Coll Cardiol EP. 2016;2:498–505.
Fukunaga M, Goya M, Nagashima M, Hiroshima K, Yamada T, An Y, et al. Identification of causative organism in cardiac implantable electronic device infections. J Cardiol. 2017;70:411–5.
Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med. 2015;373:1445–56.
Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1–50.
Kusumoto FM, Schoenfeld MH, Wilkoff BL, Berul CI, Birgersdotter-Green UM, Carrillo R, et al. 2017 HRS expert consensus statement on cardiovascular implantable electronic device lead management and extraction. Heart Rhythm. 2017;14:e503–51.
Uslan DZ, Dowsley TF, Sohail MR, Hayes DL, Friedman PA, Wilson WR, et al. Cardiovascular implantable electronic device infection in patients with Staphylococcus aureus bacteremia. Pacing Clin Electrophysiol. 2010;33:407–13.
Le Gall J, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.
Kollef M, Micek S, Hampton N, Doherty JA, Kumar A. Septic shock attributed to Candida infection: importance of empiric therapy and source control. Clin Infect Dis. 2012;54:1739–46.
Bassetti M, Merelli M, Ansaldi F, de Florentiis D, Sartor A, Scarparo C, et al. Clinical and therapeutic aspects of candidemia: a five-year single centre study. PLoS One. 2015;10:e0127534.
Tumbarello M, Posteraro B, Trecarichi EM, Fiori B, Rossi M, Porta R, et al. Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia. J Clin Microbiol. 2007;45:1843–50.
Kumamoto CA. Candida biofilms. Curr Opin Microbiol. 2002;5:608–11.
Ramage G, Saville SP, Thomas DP, López-Ribot JL. Candida biofilms: an update. Eukaryot Cell. 2005;4:633–8.
Madhavan M, Sohail MR, Friedman PA, Hayes DL, Steckelberg JM, Wilson WR, et al. Outcomes in patients with cardiovascular implantable electronic devices and bacteremia caused by Gram-positive cocci other than Staphylococcus aureus. Circ Arrhythm Electrophysiol. 2010;3:639–45.
Wilson HA, Downes TR, Julian JS, White WL, Haponik EF. Candida endocarditis: a treatable form of pacemaker infection. Chest. 1993;103:283–4.
Shmuely H, Kremer I, Sagie A, Pitlik S. Candida tropicalis multifocal endophthalmitis as the only initial manifestation of pacemaker endocarditis. Am J Ophthalmol. 1997;123:559–60.
Joly V, Belmatoug N, Leperre A, Robert J, Jault F, Carbon C, et al. Pacemaker endocarditis due to Candida albicans: case report and review. Clin Infect Dis. 1997;25:1359–62.
Kurup A, Janardhan MN, Seng TY. Candida tropicalis pacemaker endocarditis. J Inf Secur. 2000;41:275–6.
Roger PM, Boissy C, Gari-Toussaint M, Foucher R, Mondain V, Vandenbos F, et al. Medical treatment of a pacemaker endocarditis due to Candida albicans and to Candida glabrata. J Inf Secur. 2000;41:176–8.
Cacoub P, Leprince P, Nataf P, Hausfater P, Dorent R, Wechsler B, et al. Pacemaker infective endocarditis. Am J Cardiol. 1998;82:480–4.
Talarmin JP, Boutoille D, Tattevin P, Abgueguen P, Ansart S, Roblot F, et al. Candida endocarditis: role of new antifungal agents. Mycoses. 2009;52:60–6.
Falcone M, Barzaghi N, Carosi G, Grossi P, Minoli L, Ravasio V, et al. Candida infective endocarditis: report of 15 cases from a prospective multicenter study. Medicine. 2009;88:160–8.
Halawa A, Henry PD, Sarubbi FA. Candida endocarditis associated with cardiac rhythm management devices: review with current treatment guidelines. Mycoses. 2011;54(4):e168–74.
Brown LA, Baddley JW, Sanchez JE, Bachmann LH. Implantable cardioverter-defibrillator endocarditis secondary to Candida albicans. Am J Med Sci. 2001;322:160–2.
Hindupur S, Muslin AJ. Septic shock induced from an implantable cardioverter-defibrillator lead-associated Candida albicans vegetation. J Interv Card Electrophysiol. 2005;14:55–9.
Ho IC, Milan DJ, Mansour MC, Mela T, Guy ML, Ruskin JN, et al. Fungal infection of implantable cardioverter-defibrillators: case series of five patients managed over 22 years. Heart Rhythm. 2006;3:919–23.
Tascini C, Bongiorni MG, Tagliaferri E, Di Paolo A, Flammini S, Soldati E, et al. Micafungin for Candida albicans pacemaker-associated endocarditis: a case report and review of the literature. Mycopathologia. 2013;175:129–34.
Rivera NT, Bray N, Wang H, Zelnick K, Osman A, Vicuña R. Rare infection of implantable cardioverter-defibrillator lead with Candida albicans: case report and literature review. Ther Adv Cardiovasc Dis. 2014;8:193–201.
Glavis-Bloom J, Vasher S, Marmor M, Fine AB, Chan PA, Tashima KT, et al. Candida and cardiovascular implantable electronic devices: a case of lead and native aortic valve endocarditis and literature review. Mycoses. 2015;58:637–41.
Glockner A. Recurrent candidaemia and pacemaker wire infection with Candida albicans. Mycoses. 2011;54:S20–3.
Bandyopadhyay S, Tiwary PK, Mondal S, Puthran S. Pacemaker lead Candida endocarditis: is medical treatment possible? Indian Heart J. 2015;67:S100–2.
Riaz T, Nienaber JJC, Baddour LM, Walker RC, Park SJ, Sohail MR. Cardiovascular implantable electronic device infections in left ventricular assist device recipients. Pacing Clin Electrophysiol. 2014;37:225–30.
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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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
- Cardiovascular implantable electronic devices
- Lead extraction