■心室辅助装置(VAD)的使用正在增加;然而,设备并发症的诊断和管理,例如动力传动系统出口(DES)是真菌感染的入口,不是众所周知的。
■进行了涉及搜索PubMed(2005年至2020年7月)的系统评价。一名43岁的女性患者患有左VAD(LVAD)(HeartMate3,Abbott,美国)也有报道。
■患者成功使用酮康唑乳膏和口服氟康唑治疗可能的浅表DES真菌感染。我们纳入了符合我们纳入标准的36项研究;然而,我们的审查中只包括了一个。在文学中,报告5例DES真菌感染,念珠菌是唯一的真菌病原体。
■LVAD真菌感染并不常见,但可能导致高死亡率,需要长时间的治疗,当没有手术替代方案时,可能会带来巨大的问题。然而,念珠菌属最常见。真菌感染只能产生清晰的分泌物,因此,基于脓性分泌物的传动系统感染的经典定义可能会有所不同。阴性皮肤培养并不排除DES感染的诊断,因此,经验诊断可能仅基于临床。
UNASSIGNED: The use of ventricular assist devices (VAD) is increasing; however, diagnosis and management of device complications, such as the driveline exit site (DES) being the portal of entry for fungal infection, is not well known.
UNASSIGNED: A systematic review involving searching PubMed (2005 to July 2020) was conducted. The
case of a 43-year-old female patient who had a left VAD (LVAD) (HeartMate 3, Abbott, US) is also reported.
UNASSIGNED: The patient was successfully treated with ketoconazole cream and oral fluconazole for likely superficial DES fungal infections. We included 36 studies that met our inclusion criteria; however, only one was included in our review. In the literature, five cases of DES fungal infection were reported, with Candida being the only fungal pathogen.
UNASSIGNED: LVAD fungal infections are uncommon but can be responsible for high mortality rates, require a prolonged period of treatment, and can present a huge problem when surgical alternatives are not available. However, Candida species are most common. Fungal infections can only produce clear discharge, and so the classic definition of driveline infection based on purulent secretion can vary. Negative skin culture does not exclude the diagnosis of infection of the DES, and so empirical diagnosis may only be clinically based.