Candida graft vascular infections (CGVI) are rare events and little data is available in the literature. The aim of this study was to describe the characteristics and outcome of patients admitted for fungal graft vascular infections, in a reference center for CGVI treatment.
Methods: Patients admitted for a CGVI in our center from 1 January 2000 to 1 February 2018 were prospectively included. Clinical, biological, and outcome data were recorded
Results: 200 patients were admitted with graft vascular infections (GVI) in our center, and 11 of them (6%) presented CGVI. They were mainly men (7; 64%), and median age was 74 years old [min-max: 39–83]. All patients had benefited from prosthetic bypass surgery prior to CGVI, and infection was considered as an early disease in 6 patients (55%). Candida albicans was found in 72% of cases. Infection was plurimicrobial in 10 patients (92%), involving Staphyloccocus aureus in only 1 case and Bacille gram negatif in 6 (55%) cases. The management consisted in a total or partial graft replacement for 5 patients (45%), and surgical revision was required in 4 of them (30%). The empirical antifungal therapy included an echinocandin (Caspofungine) for 8 patients (73%), and was changed to fluconazole or voriconazole according to antifungigram. Two patients received Amphotericin B therapy, complicated by acute kidney injury. Intensive care unit admittance was required for nine patients (82%). After the curative treatment period, antifungal therapy could not be removed in 2 patients, and was long-continued using fluconazole. Finally, 6 patients (55%) died, all within the year after CGVI.
To our knowledge, we report here the biggest CGVI cohort. CGVI resulted in very high morbidity and mortality, requiring ICU admission for a long time. Despite multidisciplinary management involving anesthesiologists, surgeons, intensive care and infectious disease physicians, outcome of CGVI patients remains poor.
A. Pasquet, None
P. V. D'Elia, None
B. Lafon-Desmurs, None
O. Leroy, None
S. Alfandari, None
E. Senneville, None