Candidemia in Patients With Cardiovascular Implantable Electronic Devices: Uncertainty in Management Based on Current International Guidelines.
candidemia
cardiovascular implantable electronic device
diagnosis
outcome
relapse
Journal
Open forum infectious diseases
ISSN: 2328-8957
Titre abrégé: Open Forum Infect Dis
Pays: United States
ID NLM: 101637045
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
14
03
2023
accepted:
08
06
2023
medline:
10
7
2023
pubmed:
10
7
2023
entrez:
10
7
2023
Statut:
epublish
Résumé
In contrast to bloodstream infection due to a variety of bacteria in patients with cardiovascular implantable electronic devices (CIED), there are limited data regarding candidemia and risk of CIED infection. All patients with candidemia and a CIED at Mayo Clinic Rochester between 2012 and 2019 were reviewed. Cardiovascular implantable electronic device infection was defined by (1) clinical signs of pocket site infection or (2) echocardiographic evidence of lead vegetations. A total of 23 patients with candidemia had underlying CIED; 9 (39.1%) cases were community onset. None of the patients had pocket site infection. The duration between CIED placement and candidemia was prolonged (median 3.5 years; interquartile range, 2.0-6.5). Only 7 (30.4%) patients underwent transesophageal echocardiography and 2 of 7 (28.6%) had lead masses. Only the 2 patients with lead masses underwent CIED extraction, but device cultures were negative for Although current international guidelines recommend CIED removal in patients with candidemia, the optimal management strategy remains undefined. This is problematic because candidemia alone is associated with increased morbidity and mortality as seen in this cohort. Moreover, inappropriate device removal or retention can both result in increased patient morbidity and mortality.
Sections du résumé
Background
UNASSIGNED
In contrast to bloodstream infection due to a variety of bacteria in patients with cardiovascular implantable electronic devices (CIED), there are limited data regarding candidemia and risk of CIED infection.
Methods
UNASSIGNED
All patients with candidemia and a CIED at Mayo Clinic Rochester between 2012 and 2019 were reviewed. Cardiovascular implantable electronic device infection was defined by (1) clinical signs of pocket site infection or (2) echocardiographic evidence of lead vegetations.
Results
UNASSIGNED
A total of 23 patients with candidemia had underlying CIED; 9 (39.1%) cases were community onset. None of the patients had pocket site infection. The duration between CIED placement and candidemia was prolonged (median 3.5 years; interquartile range, 2.0-6.5). Only 7 (30.4%) patients underwent transesophageal echocardiography and 2 of 7 (28.6%) had lead masses. Only the 2 patients with lead masses underwent CIED extraction, but device cultures were negative for
Conclusions
UNASSIGNED
Although current international guidelines recommend CIED removal in patients with candidemia, the optimal management strategy remains undefined. This is problematic because candidemia alone is associated with increased morbidity and mortality as seen in this cohort. Moreover, inappropriate device removal or retention can both result in increased patient morbidity and mortality.
Identifiants
pubmed: 37426953
doi: 10.1093/ofid/ofad318
pii: ofad318
pmc: PMC10326679
doi:
Types de publication
Journal Article
Langues
eng
Pagination
ofad318Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
Déclaration de conflit d'intérêts
Potential conflicts of interest. LMB reports the following: royalty payments—authorship duties from UpToDate, Inc.; consultant duties for Boston Scientific; and consultant duties for Roivant Sciences. MRS reports the following: research funding and honoraria/consulting fees from Medtronic; and honoraria/consulting fee from Spectranetics, Boston Scientific, and Philips. BRP reports consulting fees from Armor Health. MM reports the following: consulting for Convatec, Biotronik Inc., and Biosense Webster; and research funding from Boston Scientific. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
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