Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections

Abstract

Mixed Candida/bacterial bloodstream infections (BSIs) have been reported to occur in more than 23% of all episodes of candidaemia. However, the clinical implications of mixed Candida/bacterial BSIs are not well known. We performed a retrospective case-control study of all consecutive patients with candidaemia over a 5-year period to determine the risk factors for and clinical outcomes of mixed Candida/bacterial BSIs (cases) compared with monomicrobial candidaemia (controls). Thirty-seven (29%) out of 126 patients with candidaemia met the criteria for cases. Coagulase-negative staphylococci were the predominant bacteria (23%) in cases. In multivariate analysis, duration of previous hospital stay ≥7 weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09–7.53), prior antibiotic therapy ≥7 days (OR, 0.33; 95% CI, 0.14–0.82) and septic shock at the time of candidaemia (OR, 2.60; 95% CI, 1.14–5.93) were significantly associated with cases. Documented clearance of candidaemia within 3 days after initiation of antifungal therapy was less frequent in cases (63% vs. 84%; p = 0.035). The difference in the rate of treatment failure at 2 weeks was not significant between cases (68%) and controls (62%; p = 0.55). The crude mortality at 6 weeks and survival through 100 days did not differ between the two patient groups (p = 0.56 and p = 0.80, respectively). Mixed Candida/bacterial BSIs showed a lower clearance rate of candidaemia during the early period of antifungal therapy, although the treatment response and survival rate were similar regardless of concurrent bacteraemia. Further studies on the clinical relevance of species-specific Candida-bacterial interactions are needed.

Searching for new strategies against polymicrobial biofilm infections: guanylated polymethacrylates kill mixed fungal/bacterial biofilms

“…a study reported 70% treatment failure for Candida/bacteria polymicrobial bloodstream infections. 8 This is in agreement with our results that 12 different antimicrobial combinations composed of first-line antibacterial and antifungal agents showed poor efficacy against mature C. albicans/S. aureus polymicrobial biofilms.…”

Candida infections in paediatrics: Results from a prospective single‐centre study in a tertiary care children's hospital

“…3,33 Finally, fungal peritonitis was mainly observed after abdominal surgery as reported in adults, 34 and only seldom as complication of peritoneal dialysis, differently from other paediatric reports. 35 This aspect, together with the low incidence of mixed Candida/bacterial bloodstream infections, that is different from that described in other studies, 36 could be due to local differences in patients' populations and case-mix.…”

Clinical Characteristics, Risk Factors and Outcomes of Mixed Candida Albicans/Bacterial Bloodstream Infections

“…Patients with candidemia have many typical risk factors, including recent surgery, exposure to broad-spectrum antibiotics, presence of a central venous catheter (CVC), and injection drug use [2]. Although many candidemia is monomicrobial, the mixed Candida/bacterial BSIs account for 18-56% as reported [4][5][6][7]. In these studies [4][5][6], some following limitations still exist: (1) Although the clinical signi cance and prognosis of mixed Candida/bacterial BSIs versus monomicrobial candidemia were investigated, few reports focused on a speci c Candida like C. albicans.…”

“…Although many candidemia is monomicrobial, the mixed Candida/bacterial BSIs account for 18-56% as reported [4][5][6][7]. In these studies [4][5][6], some following limitations still exist: (1) Although the clinical signi cance and prognosis of mixed Candida/bacterial BSIs versus monomicrobial candidemia were investigated, few reports focused on a speci c Candida like C. albicans. (2) Some reported patients with mixed Candida/bacterial BSIs had a worse prognosis than patients with monomicrobial candidemia (39% survival rate vs. 67% survival rate, P <0.05) [8], while other studies did not observe the same mortality [4][5][6].…”