Cavayas et al. recently described invasive fungal infections in patients under extra-corporeal membrane oxygenation (ECMO) of the Extracorporeal Life Support Organization registry.

They found a 1.2% prevalence of Candida bloodstream infections (BSI).

However, we highlighted the heterogeneity of this mixed population treated with veno-venous (VV) and veno-arterial (VA) ECMO and the scarce available data, in particular the delay from ECMO to infection.

As no specific report is available on Candida BSI under VA-ECMO, we investigated the incidence and timing of this complication in our large database of 150 VA-ECMO who survived more than 24h.

Antifungal therapy should not be part of the first-line empiric antimicrobial therapy in case of septic shock occurring within the first 2 weeks of ECMO support, unless indicated for other conditions.

Sepsis under prolonged mechanical support should raise the possibility of invasive Candida infection.

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