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11.02.2020 | Ausgabe 1/2021

Journal of Interventional Cardiac Electrophysiology 1/2021

Candidemia in patients with cardiovascular implantable electronic devices

Zeitschrift:
Journal of Interventional Cardiac Electrophysiology > Ausgabe 1/2021
Autoren:
Tomofumi Nakamura, Ryohsuke Narui, Benjamin Holmes, Caleb Norton, Eun-jeong Kim, Ikutaro Nakajima, William G. Stevenson, Matthew H. Greene, Roy M. John, Christopher R. Ellis, George H. Crossley III, Jay A. Montgomery
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10840-020-00706-0) contains supplementary material, which is available to authorized users.

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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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