Armaghan-E-Rehman Mansoor, Gayathri Krishnan, Julio C Zuniga-Moya, Benjamin Papadopoulus, Andrej Spec, Ige George
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Abstract
Background: Candida bloodstream infections (BSI) carry a high risk of adverse outcomes. Left ventricular assist devices (LVADs) are increasingly used to manage end-stage heart failure; however, they carry a risk of infection. This study evaluates the impact of LVAD presence on outcomes in patients with Candida BSI.
Methods: A total of 1233 patients with Candida BSI admitted to a tertiary hospital between January 2010 and December 2021 were retrospectively included, with 39 having an LVAD at the time of infection. Demographics, microbiologic data, and clinical factors associated with Candida BSI were recorded. Risk factors for Candida BSI and 30 and 90-day mortality were compared.
Results: Patients with Candida BSI in the LVAD cohort were more likely male (77% vs 54%, P = .01) versus the non-LVAD group, and more frequently had central venous access before infection (67% vs 46% P = .01). Rates of extracorporeal membrane oxygenation were higher in the LVAD group (39% vs 0.4%, P < .0001). Candida parapsilosis was the most common species in patients with LVAD (38% in LVAD vs 16%), compared to Candida albicans in the non-LVAD cohort (24% in LVAD vs 39%). HeartMate2 was the most common LVAD (21 patients, 54%). There was no difference in all-cause 30-day (30.7% vs 34.5%, P = .62) and 90-day mortality between the LVAD and non-LVAD cohorts (38.4% vs 40.7%, P = .77). In an adjusted Cox proportional hazards model, LVAD presence also did not impact 90-day mortality (hazard ratio, 1.12 [95% confidence interval, 0.70-1.77; P = .62]).
Conclusions: In patients with Candida BSI, presence of an LVAD did not impact 30- or 90-day mortality.
背景：念珠菌血流感染（BSI）具有高风险的不良后果。左心室辅助装置（lvad）越来越多地用于治疗终末期心力衰竭；然而，它们有感染的风险。本研究评估LVAD存在对念珠菌BSI患者预后的影响。方法：回顾性分析2010年1月至2021年12月在三级医院收治的1233例念珠菌BSI患者，其中39例在感染时患有LVAD。记录与念珠菌BSI相关的人口统计学、微生物学数据和临床因素。比较念珠菌BSI及30天和90天死亡率的危险因素。结果：与非LVAD组相比，LVAD组中患有念珠菌BSI的患者更多是男性（77%对54%，P = 0.01），并且在感染前更频繁地有中心静脉通道（67%对46%，P = 0.01）。LVAD组体外膜氧合率较高（39% vs 0.4%, P < 0.0001）。与非LVAD队列中的白色念珠菌（LVAD组24%对39%）相比，LVAD患者中最常见的菌种是假丝菌伴假丝菌病（LVAD组38%对16%）。HeartMate2是最常见的LVAD（21例，54%）。LVAD组和非LVAD组的全因30天死亡率（30.7% vs 34.5%, P = 0.62）和90天死亡率（38.4% vs 40.7%, P = 0.77）无差异。在调整后的Cox比例风险模型中，LVAD的存在也不影响90天死亡率（风险比为1.12[95%置信区间，0.70-1.77;P = 0.62]）。结论：在念珠菌BSI患者中，LVAD的存在对30天或90天的死亡率没有影响。
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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