Huang Ho-Yin, Lin Ying-Chi, Lu Po-Liang, Wang Ya-Ling, Chen Tun-Chieh, Chang Ko, Lin Shang-Yi
Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Microbiol Spectr. 2025 Oct 7;13(10):e0168425. doi: 10.1128/spectrum.01684-25. Epub 2025 Sep 4.
Mixed bloodstream infections (BSIs) involving and other bacterial pathogens present significant diagnostic and therapeutic challenges. The incidence of these co-infections has been increasing. However, the limited literature on this topic necessitates a deeper understanding of its epidemiological and clinical characteristics. This retrospective study evaluated adult patients with candidemia across three hospitals in Taiwan between January 2014 and December 2020. Mixed /bacterial BSIs were defined as the concurrent isolation of bacterial species from any set of blood cultures within 1 week of the initial culture. The clinical features and 30-day mortality of mixed /bacterial BSIs were investigated. Among 766 patients with candidemia, 193 (25.2%) had mixed /bacterial BSIs. The 30-day mortality for mixed infections was significantly higher than for monomicrobial candidemia (62.7% vs. 51.7%, = 0.009). The mortality rates and intervals between and bacterial blood culture isolation had a negative correlation ( = 0.004). In the mixed /bacterial BSI cases, the most common bacteria included coagulase-negative staphylococci, spp., and spp. Co-infection with vancomycin-resistant had a significantly higher mortality rate than mono-candidemia ( = 0.015). Significant predictors of 30-day mortality included high Pitt score, high sequential organ failure assessment (SOFA) score, inappropriate empiric antibiotics, and lack of adherence to the European Confederation of Medical Mycology Quality of Clinical Candidaemia Management (EQUAL) score. In conclusion, mixed /bacterial BSIs are associated with high mortality and severe clinical conditions. Empirical antibiotic strategies and tailored antifungal treatments, aligned with clinical guidelines, have significantly improved patient outcomes.IMPORTANCEMixed bloodstream infections with and bacteria are serious and deadly. This study demonstrated that /bacterial bloodstream infections (BSIs) accounted for 25.2% of all candidemia cases and were associated with significantly higher 30-day mortality compared with monomicrobial candidemia (62.7% vs 51.7%). Patients with mixed BSIs exhibited more severe clinical conditions, a higher rate of inappropriate antibiotic use, and a greater prevalence of multidrug-resistant organisms. The study further demonstrated that adherence to antifungal treatment recommendations (EQUAL score) and timely initiation of appropriate empirical antibiotics were associated with improved survival. These findings fill a critical gap in the literature and provide important insights into the management of mixed /bacterial BSIs, with implications for optimizing diagnostic and therapeutic strategies in clinical practice.
涉及念珠菌和其他细菌病原体的混合血流感染（BSIs）带来了重大的诊断和治疗挑战。这些合并感染的发生率一直在上升。然而，关于这一主题的文献有限，有必要更深入地了解其流行病学和临床特征。这项回顾性研究评估了2014年1月至2020年12月期间台湾三家医院的成年念珠菌血症患者。混合念珠菌/细菌血流感染被定义为在初次念珠菌培养后1周内从任何一组血培养中同时分离出细菌。研究了混合念珠菌/细菌血流感染的临床特征和30天死亡率。在766例念珠菌血症患者中，193例（25.2%）发生了混合念珠菌/细菌血流感染。混合感染的30天死亡率显著高于单一念珠菌血症（62.7%对51.7%，P = 0.009）。死亡率与念珠菌和细菌血培养分离之间的间隔呈负相关（P = 0.004）。在混合念珠菌/细菌血流感染病例中，最常见的细菌包括凝固酶阴性葡萄球菌、肠球菌属和大肠埃希菌属。与耐万古霉素肠球菌合并感染的死亡率显著高于单一念珠菌血症（P = 0.015）。30天死亡率的显著预测因素包括高皮特评分、高序贯器官衰竭评估（SOFA）评分、经验性抗生素使用不当以及未遵循欧洲医学真菌学联合会临床念珠菌血症管理质量（EQUAL）评分。总之，混合念珠菌/细菌血流感染与高死亡率和严重临床状况相关。符合临床指南的经验性抗生素策略和针对性抗真菌治疗显著改善了患者预后。
重要性
念珠菌与细菌的混合血流感染严重且致命。本研究表明，念珠菌/细菌血流感染（BSIs）占所有念珠菌血症病例的25.2%，与单一念珠菌血症相比，30天死亡率显著更高（62.7%对51.7%）。混合血流感染患者表现出更严重的临床状况、更高的不适当抗生素使用率以及更高的多重耐药菌患病率。该研究进一步表明，遵循抗真菌治疗建议（EQUAL评分）和及时开始使用适当的经验性抗生素与生存率提高相关。这些发现填补了文献中的关键空白，并为混合念珠菌/细菌血流感染的管理提供了重要见解，对优化临床实践中的诊断和治疗策略具有启示意义。
