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

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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 ≥7weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09-7.53), prior antibiotic therapy ≥7days (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 3days 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 2weeks was not significant between cases (68%) and controls (62%; p=0.55). The crude mortality at 6weeks and survival through 100days 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.

Original languageEnglish
Pages (from-to)62-68
Number of pages7
JournalClinical Microbiology and Infection
Volume19
Issue number1
DOIs
Publication statusPublished - 2013 Jan 1

Fingerprint

Candidemia
Candida
Bacterial Infections
Odds Ratio
Confidence Intervals
Coagulase
Therapeutics
Septic Shock
Bacteremia
Treatment Failure
Staphylococcus
Case-Control Studies
Length of Stay
Multivariate Analysis
Survival Rate
Anti-Bacterial Agents
Bacteria
Survival
Mortality

Keywords

  • Bacteraemia
  • Candidaemia
  • Co-infection
  • Risk factors
  • Treatment outcome

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

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title = "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 ≥7weeks (odds ratio (OR), 2.86; 95{\%} confidence interval (CI), 1.09-7.53), prior antibiotic therapy ≥7days (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 3days 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 2weeks was not significant between cases (68{\%}) and controls (62{\%}; p=0.55). The crude mortality at 6weeks and survival through 100days 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.",
keywords = "Bacteraemia, Candidaemia, Co-infection, Risk factors, Treatment outcome",
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T1 - Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections

AU - Kim, S. H.

AU - Yoon, Young Kyung

AU - Min, Ja Kim

AU - Sohn, Jang Wook

PY - 2013/1/1

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N2 - 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 ≥7weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09-7.53), prior antibiotic therapy ≥7days (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 3days 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 2weeks was not significant between cases (68%) and controls (62%; p=0.55). The crude mortality at 6weeks and survival through 100days 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.

AB - 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 ≥7weeks (odds ratio (OR), 2.86; 95% confidence interval (CI), 1.09-7.53), prior antibiotic therapy ≥7days (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 3days 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 2weeks was not significant between cases (68%) and controls (62%; p=0.55). The crude mortality at 6weeks and survival through 100days 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.

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KW - Treatment outcome

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