Incidence, clinical characteristics, risk factors and outcomes of patients with mixed Candida/bacterial bloodstream infections: a retrospective study

Table 2 The source of candidemia, prior antibiotic and antifungal therapy of the mixed C/B-BSIs compared with the mono-candidemia

Variable	Total (n = 296)	Mono-candidemia (n = 218)	Mixed C/B-BSIs (n = 78)	P value
Source of candidemia [n (%)]
Definitive CVC-related	108 (36.5)	83 (38.1)	25 (32.1)	0.34
Primary	79 (26.7)	53 (24.3)	26 (33.3)	0.12
Intra-abdominal	43 (14.5)	34 (15.6)	9 (11.5)	0.38
Lower respiratory tract	22 (7.4)	15 (6.9)	7 (9.0)	0.54
Gastrointestinal tract	18 (6.1)	12 (5.5)	6 (7.7)	0.68
Urinary tract infection	15 (5.1)	13 (6.0)	2 (2.6)	0.38
Skin and Soft tissue	8 (2.7)	6 (2.8)	2 (2.6)	> 0.99
Meningitis	2 (0.7)	1 (0.5)	1 (1.3)	0.46
Endocardium	1 (0.3)	1 (0.5)	0 (0.0)	> 0.99
Source control [n (%)]
Removal of contaminated lines^a	198 (67.6)	144 (66.7)	54 (70.1)	0.58
Draining of fungal collection	65 (22.0)	46 (21.1)	19 (24.4)	0.55
Prior antibiotic exposure ^b [n (%)]	235 (79.4)	164 (75.2)	71 (91.0)	< 0.01
Cephalosporins	81 (27.4)	54 (24.8)	27 (34.6)	0.10
Carbapenems	113 (38.2)	86 (39.4)	27 (34.6)	0.45
Penicillins	60 (20.3)	41 (18.8)	19 (24.4)	0.30
β-lactams	102 (34.5)	66 (30.3)	36 (46.2)	0.01
Quinolones	14 (4.7)	11 (5.0)	3 (3.8)	0.91
Initial antifungal agent [n (%)]
Fluconazole	112 (37.8)	85 (39.0)	27 (34.6)	0.49
Echinocandin	112 (37.8)	74 (33.9)	38 (48.7)	0.02
Voriconazole	35 (11.8)	30 (13.8)	5 (6.4)	0.08
Prior antifungal exposure [n (%)]	35 (11.8)	22 (10.1)	13 (16.7)	0.12
Prior azole antifungal exposure [n (%)]	21 (7.1)	12 (5.5)	9 (11.5)	0.07
Appropriate antifungal therapy ^c [n (%)]	39 (13.3)	21 (9.7)	18 (23.4)	< 0.01
Delay in initiation of empiric antifungal treatment ^d [n (%)]	203 (68.6)	158 (72.5)	45 (57.7)	0.02

CVC central venous catheter; PICC peripherally inserted central catheters; CRBSI catheter-related bloodstream infection; PCT procalcitonin test
Bold, indicates P < 0.05
^aCentral venous catheter removed within 48 h after the first positive sample
^bAll patients receiving systemic drug therapy for ≥ 3 days within 2 weeks prior to candidaemia onset
^cAntifungal therapy was defined as appropriate if the isolated Candida spp was sensitive to the chosen antifungal agent, and the antifungal agent was used with adequate dosages (like Fluconazole: loading dose of 800 mg [12 mg/kg], then 400 mg [6 mg/kg] daily; Caspofungin: loading dose of 70 mg, then 50 mg daily)
^dThe delay of empiric antifungal treatment was considered as initial use more than 12 h after the report of first positive blood sample

ISSN: 1476-0711