TABLE 1.

Impact of Candida infections of medical devices

DeviceAnnual use in the United StatesOverall rate of infection (%)Proportion of infections due to Candida (%)Mortality due to Candida infections (%)Risk factors for infection in generalRisk factors for Candida infectionsMost common Candida speciesRemoval needed to achieve cure
Vascular catheters5 × 106 (24)3-8 (24)10 (94, 96)26-38 (118)Neutropenia for >8 days; Hematologic malignancy; total parenteral nutrition; duration of site use; frequent manipulation of catheter; improper insertion and maintenance of catheter; high APACHE II score (89, 109)C. parapsilosis in blood; positive quantitative or differential time to positivity of cultures; candidemia without other source; Hyperalimentation; persistent candidemia on antifungal drugsC. albicans, C. glabrata (32, 96)Yes, in most casesb
Joint prostheses6 × 105 (24)1-3 (108)<1NKaPrior surgery; rheumatoid arthritis; immunocompromise; diabetes mellitus; poor nutrition; obesity; psoriasis; advanced age (13)NKC. albicans, C. parapsilosis (25)Yes
Dialysis access Hemodialysis fistulas2.4 × 105 (patients treated) (24)1-4 (20, 61)≪125-50 (83)PTFE grafts; number of graft revisions; nursing home residents; poor hygiene; bacterial infection at a distant site; hospitalization; duration of graft use; femoral site; diabetes mellitus; S. aureus nasal carriage (5, 61, 71)NKC. albicansYes (83)
    Hemodialysis grafts10-35 (5, 20, 61)≪1 (5)25-50 (83)NKC. albicansYes
    Peritoneal dialysis catheters23 (61)2.4-7 (39, 61, 69, 114, 117)5-25 (69, 117)Prior hospitalization; recent bacterial peritonitis; gastrointestinal diseases; prior antibiotics; lupus (39, 71)C. albicans, C. parapsilosis (69)Yes (39, 54)
Cardiac devices
    Prosthetic valves8.5 × 104 (24)2.9 (66)2-10 (45, 66)33g (112)Native valve endocarditis; black race; mechanic prosthesis (versus bioprosthesis); male sex; longer cardiopulmonary bypass time; receipt of multiple valves (16, 45)Intravenous catheters; intravenous drug use; prosthetic valve recipients; fungemia; immunosuppression; total parenteral nutrition; prior bacterial endocarditis; prolonged antibiotic use (8, 66, 78)C. albicans, C. glabrata plus C. parapsilosis (66)Yes (80, 122)
    Pacemakers4 × 105 (24)f0.5-7.0 (36, 50, 120)4.5 (6, 50, 120)NKMalnutrition; malignancy; diabetes mellitus; skin disorders; steroid or anticoagulant use (50)NKC. glabrata, C. albicansYesc (11, 52)
    ICDs2.2-7.2 (60)<1NKMedian sternotomy; longer duration of surgery; generator replacement; depressed immunity; diabetes mellitus; advanced age; another nidus of infection (107)NKC. albicansYesc (60)
    VADs700 (24)28-66 (77)25-39 (38)100 (patients with other complications affecting mortality)Postoperative bleeding necessitating reoperation; chronic underlying disease; receipt of broad-spectrum antibiotics; presence of indwelling tubes (77)NK, but possibly same as for fungal infections in ICUs (38)C. albicans, C. tropicalis (40)Yesd (38)
Central nervous system devices
    VPSs4 × 104 (24)6-15 (73, 99)1 (99)9-30 (99)Yong age; other risk factors not well documented (74)Broad-spectrum antibiotics; prior or concurrent bacterial meningitis; cerebrospinal fluid leakage; bowel perforation; abdominal surgery; steroids; indwelling catheters (35, 73, 82, 99)albicans tropicalis (35)Yese (76, 99, 104)
Urinary catheters3 × 107 (24)10-30 (24)21 (97)19.8-39 (46, 53, 105)Duration of catheterization; lack of drainage; microbial colonization of the drainage bag; diabetes mellitus; absence of antibiotic use; female sex; abnormal serum creatinine level; errors in catheter care (87)Diabetes mellitus; urinary tract infection; malignancy; antibiotic use; female sex; ICU patient (41, 53)C. albicans, C. glabrata (97, 105)Yesf
Penile implants1.5 × 104-2 × 104 (24)1-9 (17, 47)5-9.2 (75)NKUrinary tract infection; Spinal cord injury; Insertion of an inflatable device; Neurogenic bladder; Diabetes mellitus; reimplantation; revisions (18, 47)NKC. albicansYesc
  • a NK, not known.

  • b Catheter removal may not be necessary in neutropenic patients in whom the infecting fungal organisms originate primarily from the gastrointestinal tract (see the text).

  • c Based on case reports.

  • d Little evidence in the literature to guid treatment.

  • e Not well documented in the literature.

  • f If symptomatic. Includes both pacemakers and ICDs.

  • g Mortality with combined antifungal and surgical therapy.