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 language | English |
|---|---|
| Pages (from-to) | 62-68 |
| Number of pages | 7 |
| Journal | Clinical Microbiology and Infection |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2013 Jan 1 |
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Keywords
- Bacteraemia
- Candidaemia
- Co-infection
- Risk factors
- Treatment outcome
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
Cite this
Risk factors for and clinical implications of mixed Candida/bacterial bloodstream infections. / Kim, S. H.; Yoon, Young Kyung; Min, Ja Kim; Sohn, Jang Wook.
In: Clinical Microbiology and Infection, Vol. 19, No. 1, 01.01.2013, p. 62-68.Research output: Contribution to journal › Article
}
TY - JOUR
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
Y1 - 2013/1/1
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.
KW - Bacteraemia
KW - Candidaemia
KW - Co-infection
KW - Risk factors
KW - Treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=84871621449&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871621449&partnerID=8YFLogxK
U2 - 10.1111/j.1469-0691.2012.03906.x
DO - 10.1111/j.1469-0691.2012.03906.x
M3 - Article
C2 - 22651822
AN - SCOPUS:84871621449
VL - 19
SP - 62
EP - 68
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
SN - 1198-743X
IS - 1
ER -