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Candidemia in Patients With Cardiovascular Implantable Electronic Devices: Uncertainty in Management Based on Current

Supavit Chesdachai1, Larry M Baddour1,2, M Rizwan Sohail1,3

  • 1Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Open Forum Infectious Diseases
|July 10, 2023
PubMed

Insights

Limited data exist on candidemia (fungal bloodstream infection) and cardiovascular implantable electronic device (CIED) infection. Many patients with CIED and candidemia died, and optimal management remains unclear.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Medical Devices

Background:

  • Limited data exist on candidemia (fungal bloodstream infection) in patients with cardiovascular implantable electronic devices (CIEDs).
  • Understanding the risk of CIED infection in candidemia is crucial for patient outcomes.

Purpose of the Study:

  • To investigate the incidence and outcomes of candidemia in patients with CIEDs.
  • To evaluate the diagnostic criteria and management strategies for CIED infection in the context of candidemia.

Main Methods:

  • Retrospective review of patients with candidemia and CIEDs at Mayo Clinic Rochester (2012-2019).
  • CIED infection defined by clinical signs of pocket infection or echocardiographic lead vegetations.

Main Results:

  • Of 23 patients, 39.1% had community-onset candidemia; none had pocket infections.
  • Only 28.6% of those undergoing echocardiography had lead masses; only these two underwent CIED extraction.
  • 17.4% were confirmed with CIED infection, 52.2% had undefined status, and 73.9% died within 90 days.

Conclusions:

  • Current guidelines recommend CIED removal for candidemia, but optimal management is undefined.
  • Inappropriate device management (removal or retention) can increase morbidity and mortality.
  • Candidemia alone is associated with significant mortality in patients with CIEDs.
Abstract

Keywords:
candidemiacardiovascular implantable electronic devicediagnosisoutcomerelapse

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