Candidemia in Left Ventricular Assist Device Recipients: Incidence, Risk Factors, and Outcomes.

Background: Candidemia ( Methods: We screened 656 adults who underwent LVAD implantation at our institution from 1 January 2015 to 4 April 2024. Patients with C-BSI (n = 18) were compared with 2 control groups: (1) matched LVAD recipients with no bloodstream infection (N-BSI; matched 1:5; n = 90) to determine risk factors for C-BSI and (2) unmatched LVAD recipients with bacteremia (bacterial BSI [B-BSI]; n = 79) to compare mortality and infectious complication rates. A random forest model identified key predictive factors for C-BSI. Kaplan-Meier survival curves were used for time-to-event analyses. Results: Median time to C-BSI was 20 days after implantation (interquartile range, 6-42 days). Compared to N-BSI, C-BSI were more likely to require perioperative temporary mechanical circulatory support (9 patients [50%] vs 8 [8.9%], respectively), renal replacement therapy (12 [67%] vs 6 [6.7%]), total parenteral nutrition (6 [33%] vs 2 [2.2%]), and prolonged postoperative mechanical ventilation (for 12 days vs 1 day) (all Conclusions: C-BSI occurs early in LVAD recipients and is associated with a high mortality rate. Identified risk factors identified may guide antifungal prophylaxis or early empiric antifungal treatment in this susceptible patient population.