Publication Date
7-1-2023
Journal
Open Forum Infectious Diseases
DOI
10.1093/ofid/ofad318
PMID
37426953
PMCID
PMC10326679
PubMedCentral® Posted Date
6-13-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
candidemia, cardiovascular implantable electronic device, diagnosis, outcome, relapse
Abstract
BACKGROUND: In contrast to bloodstream infection due to a variety of bacteria in patients with cardiovascular implantable electronic devices (CIED), there are limited data regarding candidemia and risk of CIED infection.
METHODS: All patients with candidemia and a CIED at Mayo Clinic Rochester between 2012 and 2019 were reviewed. Cardiovascular implantable electronic device infection was defined by (1) clinical signs of pocket site infection or (2) echocardiographic evidence of lead vegetations.
RESULTS: A total of 23 patients with candidemia had underlying CIED; 9 (39.1%) cases were community onset. None of the patients had pocket site infection. The duration between CIED placement and candidemia was prolonged (median 3.5 years; interquartile range, 2.0-6.5). Only 7 (30.4%) patients underwent transesophageal echocardiography and 2 of 7 (28.6%) had lead masses. Only the 2 patients with lead masses underwent CIED extraction, but device cultures were negative for
CONCLUSIONS: Although current international guidelines recommend CIED removal in patients with candidemia, the optimal management strategy remains undefined. This is problematic because candidemia alone is associated with increased morbidity and mortality as seen in this cohort. Moreover, inappropriate device removal or retention can both result in increased patient morbidity and mortality.
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Diseases Commons, Health Information Technology Commons, Infectious Disease Commons, Medical Sciences Commons
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