Candida Bloodstream Infection in Left Ventricular Assist Device Recipients

Abstract

Purpose Left ventricular assist devices (LVADs) are being increasingly used as bridge-to-transplant and destination therapy for end-stage heart failure that is refractory to medical management. Fungal infections, especially due to Candida species, are uncommon in LVAD recipients but require special consideration in regards to management interventions. There is limited data on clinical presentation and outcome of infections due to Candida species in LVAD recipients. Methods and Materials We retrospectively reviewed hospital records of 247 patients who underwent LVAD implantation at Mayo Clinic campuses in Minnesota, Arizona and Florida, from January 2005 to December 2011. Demographic and clinical data of patients that developed infection due to Candida species were extracted. Results Of the 247 patients with LVADs, 7 (2.83%) developed infection with Candida species. The median age of seven patients was 68 years (range, 53-75 years). All patients presented with Candida blood stream infection (BSI). The causative Candida species included C. albicans (5) and C. glabrata (2). One patient underwent LVAD exchange and two patients underwent heart transplantation. Five of the seven BSI were non-LVAD-related, one was LVAD-related, and one was associated with LVAD pump/cannula infection. Patients received intravenous fluconazole (1), caspofungin (2), amphotericin (1), anidulafungin (1) and a combination of caspofungin and fluconazole (2). The average duration of anti-fungal therapy was 4.16 weeks (range, 1wk to 8.5 wks.). Two patients received lifelong antifungal suppression with oral fluconazole. Only two of the patients were alive (both had undergone orthotopic heart transplant). Average survival in this cohort of LVAD recipients with Candida BSI was 6 months (0.3 –10.5 months) from the time of candidemia. Conclusions Despite non-LVAD source of BSI in majority of cases, candidemia in LVAD recipients portends poor long-term survival. Only patients who had undergone heart transplantation survived beyond 6 months.