title: Fungemia associated with left ventricular assist device support.
abstract: OBJECTIVE
  Infections remain an important complication of left ventricular assist device (LVAD) support. While relatively uncommon, fungal infections present a serious concern given a high association with adverse events including death. We sought to further characterize the epidemiology of fungemias during LVAD support.
  
  
  METHODS
  Retrospective review of 292 patients receiving LVAD support from October 1996 to April 2009 at the University of Michigan Health System was done.
  
  
  RESULTS
  Seven cases of LVAD-associated fungemia were observed during the study period (0.1 infections/1000 days of device support). Five patients had infection with Candida species and two with Aspergillus species. The two patients with Aspergillus infection presented with disseminated disease, quickly dying of multiorgan failure, and sepsis. All five patients with Candida infections were successfully treated with systemic antifungal therapy along with transplantation in four of five patients. The fifth patient is receiving mechanical support as destination therapy. He remains on long-term suppression with high-dose fluconazole.
  
  
  CONCLUSIONS
  Fungal infections appear to be a rare but serious complication of LVAD support. Future studies should aim to improve our understanding of risk factors for fungal infection during mechanical support, especially disseminated Aspergillus. Short-term perioperative antifungal prophylaxis with fluconazole appears to be an effective and reasonable approach to prevention.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: Natasha G
authors.initials: NG
authors.lastname: Bagdasarian
authors.forename: Anurag N
authors.initials: AN
authors.lastname: Malani
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
authors.forename: Preeti N
authors.initials: PN
authors.lastname: Malani
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002177:Candidiasis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D003430:Cross-Sectional Studies; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D011474:Prosthesis Design; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole