Candidemia in Left Ventricular Assist Device Recipients: Incidence, Risk Factors, and Outcomes

Candidemia (Candida bloodstream infection [C-BSI]) in left ventricular assist device (LVAD) recipients is poorly understood. This study aimed to investigate the incidence, risk factors and outcomes of C-BSI in LVAD recipients.

We screened 656 adults who underwent LVAD implantation at our institution from 1 January 2015 to 4 April 2024. Patients with C-BSI (n = 18) were compared with 2 control groups: (1) matched LVAD recipients with no bloodstream infection (N-BSI; matched 1:5; n = 90) to determine risk factors for C-BSI and (2) unmatched LVAD recipients with bacteremia (bacterial BSI [B-BSI]; n = 79) to compare mortality and infectious complication rates. A random forest model identified key predictive factors for C-BSI. Kaplan-Meier survival curves were used for time-to-event analyses.

Median time to C-BSI was 20 days after implantation (interquartile range, 6-42 days). Compared to N-BSI, C-BSI were more likely to require perioperative temporary mechanical circulatory support (9 patients [50%] vs 8 [8.9%], respectively), renal replacement therapy (12 [67%] vs 6 [6.7%]), total parenteral nutrition (6 [33%] vs 2 [2.2%]), and prolonged postoperative mechanical ventilation (for 12 days vs 1 day) (all P < .001). A random forest model identified ventilation duration, renal replacement therapy, and total parenteral nutrition as top predictors of C-BSI. In terms of outcomes, C-BSI was more likely to lead to device endocarditis than B-BSI (in 5 [28%] vs 7 [9.1%], respectively; P = .008) and was associated with shorter median survival after infection (25 [interquartile range, 12 to not estimable due to censoring] vs 490 [54 to not estimable due to censoring] days; P = .04).

C-BSI occurs early in LVAD recipients and is associated with a high mortality rate. Identified risk factors identified may guide antifungal prophylaxis or early empiric antifungal treatment in this susceptible patient population.