Chesdachai Supavit, Baddour Larry M, Sohail M Rizwan, Palraj Bharath Raj, Madhavan Malini, Tabaja Hussam, Fida Madiha, Challener Douglas W, DeSimone Daniel C
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Open Forum Infect Dis. 2023 Jun 13;10(7):ofad318. doi: 10.1093/ofid/ofad318. eCollection 2023 Jul.
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 species. Two (33.3%) of 6 other patients who were managed as candidemia without device infection subsequently developed relapsing candidemia. Cardiovascular implantable electronic device removal was done in both patients and device cultures grew species. Although 17.4% of patients were ultimately confirmed to have CIED infection, CIED infection status was undefined in 52.2%. Overall, 17 (73.9%) patients died within 90 days of diagnosis of candidemia.
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.
与心血管植入式电子设备（CIED）患者因多种细菌引起的血流感染相比，关于念珠菌血症及CIED感染风险的数据有限。
回顾了2012年至2019年在罗切斯特梅奥诊所患有念珠菌血症且植入CIED的所有患者。心血管植入式电子设备感染的定义为：（1）囊袋部位感染的临床体征；或（2）导线赘生物的超声心动图证据。
共有23例患有念珠菌血症的患者植入了CIED；9例（39.1%）为社区发病。所有患者均无囊袋部位感染。CIED植入与念珠菌血症之间的时间间隔延长（中位数3.5年；四分位间距，2.0 - 6.5年）。仅7例（30.4%）患者接受了经食管超声心动图检查，其中2例（28.6%）有导线肿物。仅2例有导线肿物的患者接受了CIED拔除，但设备培养未检出相关菌种。另外6例按念珠菌血症处理且无设备感染的患者中有2例（33.3%）随后发生复发性念珠菌血症。这2例患者均进行了CIED拔除，设备培养检出相关菌种。尽管最终17.4%的患者被确诊为CIED感染，但52.2%的患者CIED感染状态不明确。总体而言，17例（73.9%）患者在念珠菌血症诊断后90天内死亡。
尽管当前国际指南建议对患有念珠菌血症的患者拔除CIED，但最佳管理策略仍不明确。这存在问题，因为如本队列所示，仅念珠菌血症就与发病率和死亡率增加相关。此外，不适当的设备拔除或保留均可导致患者发病率和死亡率增加。
