title: Candida endocarditis associated with cardiac rhythm management devices: review with current treatment guidelines.
abstract: Coincident 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 CRMD-related 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.
authors.affiliation: Department of Internal Medicine, James H Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Halawa
authors.forename: Philip D
authors.initials: PD
authors.lastname: Henry
authors.forename: Felix A
authors.initials: FA
authors.lastname: Sarubbi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000145:classification / Q000302:isolation & purification*; D002177:Candidiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D004696:Endocarditis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents