Comparative outcomes following Candida bloodstream infection in patients with left ventricular assist devices

Background Candida bloodstream infections (BSI) carry a high risk of adverse outcomes. Left ventricular assist devices (LVAD) 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 1233 patients with Candida BSI admitted to a tertiary hospital between January 2010-December 2021 were retrospectively included, with 39 having an LVAD at 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=0.01) vs the non-LVAD group, and more frequently had central venous access before infection (67% vs 46% p=0.01). Rates of extracorporeal membrane oxygenation were higher in the LVAD group (39% vs 0.4%, p <0.0001). C. parapsilosis was the most common species in patients with LVAD (38% in LVAD vs 16%), compared to C. 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=0.62) and 90-day mortality between the LVAD and non-LVAD cohorts (38.4% vs 40.7%, p=0.77). In an adjusted Cox proportional-hazards model, LVAD presence also did not impact 90-day mortality (HR 1.12 [95% CI: 0.70-1.77; p=0.62]). Conclusion In patients with Candida BSI, presence of an LVAD did not impact 30 or 90-day mortality.