Predictors for Mixed C albicans Bacterial Bloodstream Infections During Hospitalization

A high prevalence of mixed Candida albicans/bacterial bloodstream infections (mixed-CA/B-BSIs) was observed among patients with long stays in the intensive care unit (ICU), according to findings published in BMC Infectious Diseases.

This single-center, retrospective cohort study explored the clinical features and outcomes of mixed-CA/B-BSI compared with monomicrobial C albicans bloodstream infections in adult patients. Patients (N=117) who tested positive for C albicans between 2013 and 2018 were included in this study. Electronic medical records were assessed for clinical outcomes.

Patients were a median age of 68 years (interquartile range [IQR], 59-75), 58.1% were men, 79.5% had mono-Candida albicans bloodstream infections (CA-BSI), and 20.5% had mixed-CA/B-BSIs. These patients were being treated in the ICU (66.7%), surgical ward (23.9%), and general medical ward (9.4%).

Prior to bloodstream infection, patients with mixed-CA/B-BSIs had longer durations in the ICU (12.0 vs 1.0 days; P =.001), in the hospital (19.0 vs 12.0 days; P =.031), on mechanical ventilation (11.0 vs 1.0 days; P =.013), and prior antibiotic exposure (17.0 vs 8.0; P =.007). These patients were more likely to require life-sustaining interventions such as intra-abdominal catheters (P =.015), mechanical ventilation (P =.020), multiple central venous catheters (P =.022), and continuous renal replacement therapy (P =.044).

A stay in the intensive care unit for more than 2 days before a bloodstream infection was an independent predictor for mixed-CA/B-BSIs (odds ratio [OR], 7.445; 95% CI, 1.152-48.132; P =.035).

Among the patients with mixed-CA/B-BSIs, the most common copathogens were coagulase-negative Staphylococcus (24.0%), Klebsiella pneumoniae (20.0%), and Staphylococcus aureus (16.0%).

This study was limited by its single-center design. The observed infection patterns may be unique to some part of the local ecology or to the center-specific sanitation practices.

These data indicated mixed-CA/B-BSIs were relatively common among C albicans infections and patients with mixed infections were more likely to have longer hospital stays and need life-sustaining interventions. Despite these observed differences, mixed-CA/B-BSIs did not appear to effect prognosis or mortality.

Reference

Zhong L, Zhang S, Tang K, et al. Clinical characteristics, risk factors and outcomes of mixed Candida albicans/bacterial bloodstream infections. BMC Infect Dis. 2020;20(1):810. doi:10.1186/s12879-020-05536-z