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Published on: November 6, 2020
Survival of candida sepsis in extracorporeal membrane oxygenation
Mary S Minette1, Laura M Ibsen
1Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health Sciences University, Portland, OR, USA.
Insights
Fungal sepsis, specifically candidemia, does not preclude extracorporeal membrane oxygenation (ECMO) support in infants. With appropriate antifungal treatment and supportive care, survival is achievable for critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Cardiovascular surgery
Background:
- Extracorporeal membrane oxygenation (ECMO) is a life-support measure for neonates and children with severe cardiorespiratory failure.
- Fungal sepsis, particularly candidemia, presents a significant challenge in critically ill patients, often leading to treatment withdrawal or contraindication for advanced support.
- Congenital heart disease (CHD) requiring surgical repair necessitates intensive care and can be complicated by systemic infections.
Observation:
- A single case report details an infant with complex congenital heart disease who developed Candida sepsis while on postoperative ECMO support.
- The infant experienced a prolonged episode of candidemia following surgical repair of CHD.
- Despite the severity of sepsis and need for ECMO, the patient received targeted antifungal therapy and inotropic support.
Findings:
- The infant successfully survived the prolonged candidemia and ECMO support period.
- At 6-month follow-up, the patient exhibited no sequelae and was undergoing long-term fluconazole therapy for Candida endocarditis.
- Bloodstream sterility was eventually achieved, allowing for decannulation and catheter removal.
Implications:
- Candidemia, including Candida albicans, should not be considered an absolute contraindication for ECMO in pediatric patients.
- Aggressive antifungal therapy combined with hemodynamic support can facilitate survival in ECMO patients with fungal sepsis.
- This case highlights the potential for successful outcomes in complex pediatric cases with combined critical care, infectious disease, and surgical management.
Objective:
To report the survival of fungal sepsis in extracorporeal membrane oxygenation.
Design:
Single case report.
Setting:
Tertiary referral children's hospital pediatric intensive care unit.
Patients:
A single case report of an infant with congenital heart disease who developed candida sepsis while supported postoperatively with extracorporeal membrane oxygenation.
Results:
This infant survived a prolonged episode of candidemia after repair of congenital heart disease, which required extracorporeal membrane oxygenation support. The patient has no identified sequelae at 6-month follow-up and continues on long-term fluconazole therapy for candida endocarditis.
Conclusions:
Candidemia, particularly Candida albicans species, may not be a contraindication for extracorporeal membrane oxygenation support. With antifungal therapy and adequate inotropic use to counter the effects of septicemia, survival can be maintained until the patient adequately recovers, allowing decannulation, removal of all catheters, and eventual bloodstream sterility.
