Synchronous Bacterial and Fungal Septicemia. A Marker for the Critically Ill Surgical Patient

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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 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 physican to strongly suspect disseminated fungal infection and to commence appropriate treatment. Mortality is likely to remain high unless the underlying disease can be rapidly corrected and infection controlled.