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Clinical insights into mixed Candida and bacterial bloodstream infections: a retrospective cohort study

Summary

This study found that when both Candida fungus and bacteria are present together in a patient’s bloodstream, the outcome is much more serious than when only Candida is present. Among patients with these mixed infections, over 60% died within 30 days compared to about 52% for those with only Candida. The research shows that giving the right antibiotics early and following proper treatment guidelines can significantly improve survival chances in these severe, life-threatening infections.

Background

Mixed bloodstream infections involving Candida and bacteria present significant diagnostic and therapeutic challenges with increasing incidence. These co-infections account for over 20% of candidemia cases and are associated with higher mortality rates and adverse patient outcomes compared to monomicrobial candidemia.

Objective

This retrospective cohort study evaluated adult patients with candidemia across three hospitals in Taiwan to determine the frequency, clinical characteristics, and 30-day mortality predictors in patients with mixed Candida/bacterial bloodstream infections.

Results

Among 766 patients with candidemia, 193 (25.2%) had mixed Candida/bacterial BSIs with significantly higher 30-day mortality compared to monomicrobial candidemia (62.7% vs 51.7%, P=0.009). Most common bacteria were coagulase-negative staphylococci, Enterococcus spp., and Klebsiella spp. High Pitt score, high SOFA score, and inappropriate empiric antibiotics predicted mortality, while appropriate antibiotics and high EQUAL score were protective factors.

Conclusion

Mixed Candida/bacterial BSIs are associated with high mortality and severe clinical conditions. Empirical antibiotic strategies tailored to regional epidemiology and adherence to antifungal treatment guidelines (EQUAL score) significantly improve patient outcomes. These findings highlight the critical need for heightened vigilance and tailored therapeutic strategies for managing mixed Candida/bacterial BSIs.
  • Published in:Microbiology Spectrum,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 40905674; DOI: 10.1128/spectrum.01684-25
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