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

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Devices

Background:

• Candidemia (Candida bloodstream infection [C-BSI]) in left ventricular assist device (LVAD) recipients is not well understood.
• This study investigates the incidence, risk factors, and outcomes of C-BSI in LVAD recipients.

Purpose of the Study:

• To determine the incidence, risk factors, and outcomes of candidemia in patients with left ventricular assist devices.
• To identify key predictors of C-BSI using a random forest model.

Main Methods:

• Retrospective analysis of 656 adult LVAD recipients from January 2015 to April 2024.
• Comparison of 18 C-BSI patients with 90 LVAD recipients without bloodstream infection (N-BSI) and 79 with bacterial bloodstream infection (B-BSI).
• Utilized random forest modeling for predictive factor identification and Kaplan-Meier curves for survival analysis.

Main Results:

• C-BSI occurred at a median of 20 days post-implantation and was associated with increased need for mechanical circulatory support, renal replacement therapy, total parenteral nutrition, and prolonged ventilation.
• Top predictors for C-BSI included ventilation duration, renal replacement therapy, and total parenteral nutrition.
• C-BSI led to higher rates of device endocarditis and significantly shorter median survival compared to bacterial BSI.

Conclusions:

• Candidemia in LVAD recipients is an early complication associated with high mortality.
• Identified risk factors may inform antifungal prophylaxis or early empiric treatment strategies for this vulnerable population.