*Purpose: Fungal infections represent an uncommon etiology of Left Ventricular Assist Device (LVAD) infections but can lead to significant morbidity and mortality. In this study, we sought to examine the clinical features and outcomes of candida blood stream infection (candidemia) in patients with LVADs.

*Methods: We retrospectively analyzed all adult patients with LVAD who developed candidemia at a tertiary academic center from 01/2010 to 08/2020. Primary end points were thirty-day mortality, six-month mortality and recurrence of infections. Univariate Chi-square and Fischer’s exact test were used for categorical variables and t-test for continuous variables.

*Results: Among 41 LVAD patients with candidemia, 11 (26.8%) experienced the first episode of candidemia within 30 days and 21 (51.2%) had the first episode within the 100 days after LVAD placement. Sepsis with septic shock was the most common presentation (21/41, 51.2%) and C. parapsilosis was the most common species isolated (17/41, 41.5%). Large proportion required ICU admission (78%) and had underlying Chronic Kidney Disease (66.7%). Heartmate2 (23/41, 56.1%) was the most common LVAD in these patients followed by Heartware (9/41, 22.0%). Most patients (97.5%) had antibiotic exposure in the 30 days preceding candidemia. Micafungin was the most used initial antifungal therapy (30/41, 73.2%). Overall mortality in patients with candidemia was 80.5% with 36.6% and 53.7% mortality within 30 days and 6 months of candidemia, respectively. Among 19/41 patients who survived till 1 year, candidemia recurrence occurred in 9/19 (47.3%). Risk factors for 30-day mortality were older age (p=0.08), initial clinical presentation of sepsis with septic shock (p=0.03) or stroke with embolic phenomenon (p=0.05) and need for Intensive Care Unit (ICU) admission (p=0.02). Risk factors for 6 months mortality were older age (p=0.03), male gender (p=0.05), and diabetes mellitus (p=0.06). Chronic antifungal suppression after initial treatment was associated with lower 6 months mortality (p= 0.001). Median time to onset of candidemia from LVAD placement was 48 days among people who died at 6 months and 341 days for the survivors.

*Conclusions: This is the largest single-center study analyzing candidemia in LVAD patients to date. Candidemia is associated with high mortality and high rate of recurrence in survivors. Earlier onset of candidemia after LVAD placement is associated with higher mortality. Older age, male gender and need for ICU admission are significant risk factors for candidemia-associated mortality in LVAD patients.

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