Polymicrobial candidemia

We conducted a retrospective review of the clinical data on patients with polymicrobial candidemia during a nine-year period (1992-2000) at our tertiary care University Hospital. Also, the clinical features of patients with polymicrobial vs monomicrobial candidemia were compared. There were 16 (5.2%) patients with multiple candidal species in blood among 303 patients with candidemia. Patients' age varied from 21-85 years (median 52 years); they had serious underlying co-morbidities with prolonged hospitalization (median duration 13 days); all had intravenous vascular catheters, had been exposed to multiple antibiotics and were heavily colonized with Candida. Concomitant serious bacterial infections were common (56%). Candida albicans was isolated from blood in 11 of 16 patients; other species were C. glabrata (7 patients), C. tropicalis (6 patients) and C. parapsilosis (4 patients). Sixty seven percent (8 of 12) patients had causative Candida species isolated from vascular catheter tip culture. Polymicrobial candidemia occurred in sicker, non-oncologic patients with frequent concomitant bacterial infections, as compared to those with monomicrobial candidemia. Crude mortality was 43%, a rate similar to that seen with monomicrobial candidemia. Polymicrobial candidemia is uncommon, seen in hospitalized patients with multiple co-morbidities and heavy candidal colonization; removal of vascular catheter and institution of antifungal therapy are important therapeutic maneuvers.