Candida endocarditis associated with cardiac rhythm management devices: review with current treatment guidelines

Abstract

SummaryCoincident with an increased use of cardiac rhythm management devices (CRMD) has been an increase in the number of pacemaker and cardioverter-defibrillator infections. CRMD endocarditis accounts for about 10% of all device-related infections, and cardiac infection caused by Candida sp. is a rare event. To date, only sporadic reports of this unusual and life-threatening event have been reported. By describing a case of CRMDrelated Candida endocarditis and conducting a literature review, we provide a detailed characterisation of this unusual clinical entity with an emphasis on diagnosis, management and treatment. A case of CRMD-related Candida endocarditis is presented and a computer search for confirmed cases of CRMD-Candida endocarditis was conducted. Current recommendations for management and treatment were documented. From 1969 to 2009, 15 patients with CRMD-Candida endocarditis (12 pacemaker and three implanted cardioverter-defibrillator) were documented. All were males, non-albicans Candida sp. were frequently recovered, a major fungal embolus occurred in 27% of patients and two of 10 patients who received defined antifungal therapy and device explantation expired. CRMD Candida endocarditis is a rare and serious clinical event; isolates can include Candida albicans and other Candida sp., and treatment involves both targeted antifungal therapy and device removal.

Invasive Candidiasis

“…[77][78][79][80][81][82] The entire device should be removed and antifungal therapy given for 4 to 6 weeks depending on whether the infection involves the wires in addition to the generator pocket. 77,[79][80][81][82] Medical therapy alone is usually inadequate. 78 There are also isolated case reports of Candida infections involving ventricular assist devices.…”

Fighting fungus with a laser and a hose: Management of a giant Candida albicans implantable cardioverter‐defibrillator lead vegetation with simultaneous AngioVac aspiration and laser sheath lead extraction

“…Fungal infections of cardiac implantable electronic devices are uncommon and very challenging to manage . They are characterized by the presence of bulky vegetations, recurrent septic emboli, and persistence despite aggressive antimicrobial therapy.…”

“…They are characterized by the presence of bulky vegetations, recurrent septic emboli, and persistence despite aggressive antimicrobial therapy. Complete removal of the infected system and long‐term post‐extraction antimicrobial therapy provide the best likelihood of success . The presence of large vegetations and the attendant risk of life‐threatening pulmonary artery embolization may necessitate open heart surgery for safer extraction, but the patients who would benefit most from this approach may have co‐morbidities that make them poor surgical candidates.…”

Invasive Candidiasis in Patients with Implants

“…About 5% of cardiac rhythm management device infections are due to Candida [52]. Infection can occur at the leads or in the device pocket and can be secondarily complicated by endocarditis [53]. Clearance of infection is unlikely without complete removal of the device.…”