Bouza Santiago, EmilioBurillo Albizua, AlmudenaMuñoz García, Patricia CarmenGuinea, JesúsMarín Arriaza, María De Las MercedesRodríguez Creixems, Marta2025-11-182025-11-182013-03-27Emilio Bouza, Almudena Burillo, Patricia Muñoz, Jesús Guinea, Mercedes Marín, Marta Rodríguez-Créixems, Mixed bloodstream infections involving bacteria and Candida spp., Journal of Antimicrobial Chemotherapy, Volume 68, Issue 8, August 2013, Pages 1881–1888, https://doi.org/10.1093/jac/dkt0990305-745310.1093/jac/dkt099https://hdl.handle.net/20.500.14352/126166Este estudio analiza las infecciones mixtas de torrente sanguíneo que involucran simultáneamente bacterias y Candida spp. (mixed-BSI), una entidad poco reconocida y de relevancia creciente. Se revisaron todos los episodios de bacteriemia y fungemia registrados en un hospital terciario entre 2000 y 2010: las mixed-BSI representaron el 0,7% de todas las infecciones sanguíneas, el 6,9% de las bacteriemias polimicrobianas y el 18% de todas las candidemias. Su incidencia aumentó de 0,08 a 0,34 casos/1000 ingresos. La mayoría se asociaron a pacientes críticos, con mayor frecuencia ingresados en UCI y con catéteres intravenosos. Comparadas con las bacteriemias polibacterianas, las mixed-BSI se asociaron a mayor gravedad clínica, más uso de antimicrobianos, mayor estancia hospitalaria y mayor mortalidad. En comparación con las candidemias puras, los pacientes tenían enfermedades subyacentes más graves, mayores puntuaciones APACHE II y más shock séptico, aunque la mortalidad no fue significativamente diferente. Se concluye que las mixed-BSI representan una infección distinta, grave y en aumento, que afecta a pacientes muy complejos y con elevada morbimortalidad.Objectives: Polymicrobial bloodstream infection (BSI) is an imprecisely defined entity purportedly associated with a worse outcome than monomicrobial BSI. This study examines trends in BSI episodes caused by bacteria and Candida spp. (mixed-BSI) in a large teaching hospital. Methods: All episodes of BSI from January 2000 to December 2010 were reviewed. Three groups (n = 54 each) of patients were compared: all adults with mixed-BSI from January 2006 to December 2010 (cases) and randomly selected patients with polybacterial BSI (polyB-BSI) (Control 1) or Candida spp. BSI (Candida-BSI) (Control 2) in this same period. Results: A total of 139 episodes of mixed-BSI were recorded (0.7% of all BSI, 6.9% of all poly-BSI and 18.0% of all Candida-BSI episodes). The incidence of mixed-BSI was 0.21 cases/1000 admissions, increasing from 0.08 (2000) to 0.34 (2010) cases/1000 admissions (P = 0.007). Mixed-BSI represented 11.8% and 22.9% of all episodes of candidaemia in 2000 and 2010, respectively (P = 0.011). Compared with polyB-BSI, mixed-BSI patients showed fewer malignancies, more frequent nosocomial or intravenous catheter BSI source and less frequent intra-abdominal origin, were more frequently admitted to an intensive care unit (ICU), received more antimicrobials and showed a longer hospital stay and higher mortality. Compared with Candida-BSI, mixed-BSI patients showed more severe underlying diseases, were more frequently admitted to an ICU or oncology-haematology unit, showed a higher APACHE II score, more often progressed to septic shock or multiorgan failure and received more antimicrobials. Mortality was similar.engjournal article1460-2091https://doi.org/10.1093/jac/dkt09923535881https://academic.oup.com/jac/article/68/8/1881/866543?login=truehttps://pubmed.ncbi.nlm.nih.gov/23535881/restricted access616.5-002.828Mixed bloodstream infectionBacteraemiaCandidaemiaPolymicrobial infectionCoinfectionCandida spp.MedicinaMicrobiología médica32 Ciencias Médicas3201.03 Microbiología Clínica