Incidence, clinical characteristics, risk factors and outcomes of patients with mixed Candida/bacterial bloodstream infections: a retrospective study

Ann Clin Microbiol Antimicrob. 2022 Nov 1;21(1):45. doi: 10.1186/s12941-022-00538-y.

Abstract

Purpose: The mixed Candida/bacterial bloodstream infections (mixed C/B-BSIs) is worthy of particular attention recently, and we analyzed the incidence, co-pathogens, clinical characteristics, risk factors, and outcomes of mixed C/B-BSIs compared with monomicrobial candidemia (mono-candidemia) in adult patients in China.

Methods: All hospitalized adults with candidemia were recruited for this retrospective observational study from January 1, 2013, to December 31, 2019.

Results: Of the 296 patients with candidemia, 78 cases (26.3%) were mixed C/B-BSIs. Candida albicans (C. albicans) was the most common Candida species among all candidemia, and Klebsiella pneumoniae (K. pneumoniae) was the most concomitant bacteria (30.6%), followed by Acinetobacter baumannii (A. baumannii) (12.9%) and Enterococcus faecium (E. faecium) (11.8%) in mixed C/B-BSIs. In the multivariable analysis, prior β-lactams exposure [adjusted odds ratio (aOR), 1.97; 95% confidence interval (CI), 1.01-3.87], burn injury (aOR, 6.35; 95% CI 1.82-22.21) and continuous renal replacement therapy (CRRT) (aOR, 3.00; 95% CI 1.46-6.17) were independent risk factors for mixed C/B-BSIs. Compared with mono-candidemia, patients with mixed C/B-BSIs developed with more proportion of septic shock (55.1% vs. 39.9%, P < 0.05), prolonged stay in ICU [22.0(12.0-57.0) vs. 9.5(0.0-37.0) days, P < 0.001] and longer mechanical ventilation time [19.0(4.5-40.8) vs. 6.0(0.0-24.8) days, P < 0.001]. The in-hospital mortality in patients with mixed C/B-BSIs was higher than those with mono-candidemia (59.0% vs. 34.9%, P < 0.001). Survival analysis revealed that 28-day and 60-day mortality were significantly higher in patients with mixed C/B-BSI than in those with mono-candidemia (57.7% vs. 31.7%, P < 0.001; 59.0% vs. 34.9%, P < 0.001; respectively).

Conclusions: There is a high rate of mixed C/B-BSIs cases among candidemia, and K. pneumoniae is the predominant coexisting species. Prior β-lactams exposure, burn injury, and CRRT are independent risk factors for mixed C/B-BSIs. The mortality of patients with mixed C/B-BSIs is significantly higher than those with mono-candidemia, this deserves further attention for clinicians.

Keywords: Bloodstream infections; Candida albicans; Candidemia; Mixed Candida/bacterial bloodstream infections; Mortality; Risk factor.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Bacteria
  • Bacterial Infections*
  • Candida
  • Candida albicans
  • Candidemia* / drug therapy
  • Candidemia* / epidemiology
  • Candidemia* / microbiology
  • Candidiasis* / microbiology
  • Coinfection*
  • Humans
  • Incidence
  • Klebsiella pneumoniae
  • Retrospective Studies
  • Risk Factors
  • beta-Lactams / therapeutic use

Substances

  • beta-Lactams