268: Fungemia in Patients with Long-Term Left Ventricular Assist Devices: A Chronic Problem, but Not the Kiss of Death

Purpose: Patients with long-term ventricular assist devices (LVAD) have a high risk of morbidity and mortality from infection. Use of broad-spectrum antibiotics may predispose to fungal infections for which treatment options may be limited. The outcomes in LVAD patients with fungemia, like other cardiac devices, is presumed to be poor – and yet, is poorly defined. We reviewed our experience and outcomes with LVAD associated fungemia. Methods and Materials: Between 01/2001 and 07/2007, 80 patients underwent planned LVAD placement. Mean age was 53 11 years. Therapy goal was bridge to transplant in 33 (41%) and destination in 47. Nine (11 %) developed fungemia. The outcomes were compared to the remaining non-fungemic LVAD group. T-testing and survival analyses were used to compare groups. Results: Candida albicans species were cultured in 4 pts with the remainder being other fungi. Time from implant to fungemia was 125 144 days (range: 6-426). But time from fungemia to death being 124 83 days. Five patients were discharged following initial diagnosis. Causes of death were sepsis (n 2), cerebral bleed (3), cardiac (1), refused treatment (1), unknown at home (1). One is still alive. Conclusions: Fungemia in LVAD patients can be chronically controlled, often as an out-patient, but tends to limit transplantability, and hence overall survival. Empiric anti-fungal treatments must cover a diverse spectrum of pathogens. Septic death is uncommon and prolonged survival post diagnosis may reflect aggressive anti-infection strategies.