Candidemia in patients with cardiovascular implantable electronic devices.

Autor: Nakamura T; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Narui R; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Holmes B; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Norton C; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Kim EJ; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Nakajima I; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Stevenson WG; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Greene MH; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA., John RM; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Ellis CR; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Crossley GH 3rd; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA., Montgomery JA; Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, 1215 21st Ave S. Room 5429, Nashville, TN, 37232, USA. jay.a.montgomery@vanderbilt.edu.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2021 Jan; Vol. 60 (1), pp. 69-75. Date of Electronic Publication: 2020 Feb 11.
DOI: 10.1007/s10840-020-00706-0
Abstrakt: 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.
Databáze: MEDLINE
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