Candida Bloodstream Infection in Left Ventricular Assist Device Recipients: Case Series and Review of the Literature

Candida bloodstream infection (C-BSI) is a rare infection in patients with left ventricular assist devices (LVADs). We aim to describe the characteristics and outcomes of C-BSI. We performed a retrospective search for C-BSI in patients with LVADs at our institution from January 2012 to May 2024. We then performed a literature review using the keywords 'fungemia ventricular assist device', 'candidemia ventricular assist device', 'Candida bloodstream infection ventricular assist device,' or 'Candida endocarditis ventricular assist device' from 1990 to 2024. Clinical characteristics and outcomes were extracted. We identified three institutional cases along with 21 additional cases from the literature. The incidence of candidemia was 3.1% (3/97) and 1.8% (16/867), respectively, in the case series and literature review. Mean age was 45.6 years (range 19-73 years), and average body mass index (BMI) was 31.8 kg/m². There was a 100% mortality rate in our cohort and 62.5% in the literature review cohort. Among the surviving patients in the literature review, 66.7% underwent heart transplantation, and 33.3% were discharged on antifungal therapy. 41.2% experienced right heart failure, with four requiring temporary mechanical circulatory support post-operatively. Obesity was present in 75.0% of patients, and 42.1% had an LVAD-related infection. C-BSI developed after an average of 426 days of LVAD support, with 33.3% occurring within 30 days postoperatively. The average duration of C-BSI was 29 days. Candida auris was the most common species. C-BSI is a rare fatal complication in LVAD patients. Obesity, delayed sternal wound closure, and right heart failure may contribute to these poor outcomes.