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Synchronous bacterial and fungal septicemia. A marker for the critically ill surgical patient
A Verghese1, K Prabhu, R D Diamond
1Department of Internal Medicine, East Tennessee State University College of Medicine, Johnson City 37614-0002.
Abstract:
Mixed septicemia (synchronous fungal and bacterial septicemia) is an occasional, but often fatal occurrence in the critically ill patient. We reviewed 14 such cases at two hospitals. Twelve of 14 patients were in the surgical intensive care unit. Eleven patients had an average of 2.7 major surgical procedures (range 2 to 4); persistent post-operative peritoneal sepsis was common occurring in 9 patients. Bacteremia preceded mixed septicemia in 8 of 14 cases and gram negative enteric bacilli were the most common causes of bacteremia. Fungemia was due to Candida species in 13 of 14 patients and followed prolonged antibiotic therapy. The diagnosis of disseminated candidiasis was suspected during life in 13 patients and proven in six. Mixed septicemia is a marker for a distinct population of critically ill surgical patients with a high overall mortality (78% in this study). Culture of both a fungal and bacterial pathogen in a blood culture, especially if preceded by bacteremia, should alert the physician to strongly suspect disseminated fungal infection and to commence appropriate treatment. Mortality is likely to remain high unless the underlying disease states can be rapidly corrected and infection controlled.
Insights
Mixed septicemia, a serious condition involving both fungal and bacterial infections, affects critically ill patients, particularly in surgical intensive care units. Early detection and treatment are crucial for improving survival rates in these high-mortality cases.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Surgical Infections
Background:
- Mixed septicemia, a concurrent fungal and bacterial bloodstream infection, presents a significant challenge in critically ill patients.
- This condition is often fatal and necessitates a thorough understanding of its predisposing factors and clinical presentation.
Observation:
- A review of 14 cases revealed that most patients were in surgical intensive care units and had undergone multiple major surgeries.
- Persistent post-operative peritoneal sepsis was a common preceding condition.
- Bacteremia, frequently caused by gram-negative enteric bacilli, often preceded the mixed septicemia.
Findings:
- Fungemia, predominantly caused by Candida species, typically followed prolonged antibiotic therapy.
- Disseminated candidiasis was suspected in most patients during their lifetime.
- Mixed septicemia is associated with a high mortality rate (78% in this study), marking a distinct high-risk patient group.
Implications:
- Positive blood cultures for both fungal and bacterial pathogens, especially after bacteremia, warrant strong suspicion of disseminated fungal infection.
- Prompt initiation of appropriate antifungal and antibacterial treatment is critical.
- Improving outcomes hinges on rapid correction of underlying disease states and effective infection control.