| Summary: | <b>Background:</b> Pediatricians face a therapeutic challenge when patients with <i>Candida</i> bloodstream infections (BSIs) simultaneously have positive bacterial culture. We aim to characterize the clinical characteristics of pediatric <i>Candida</i> BSIs complicated with mixed bacteremia and subsequent bacterial infections, risk factors and impacts on outcomes. <b>Methods:</b> All episodes of pediatric <i>Candida</i> BSIs between 2005 and 2020 from a medical center in Taiwan were reviewed. Mixed <i>Candida</i>/bacterial BSIs were defined as isolation of a bacterial pathogen from blood cultures obtained within 48 h before or after the onset of <i>Candida</i> BSI. The clinical features and impacts of mixed <i>Candida</i>/bacterial BSIs were investigated. <b>Results:</b> During the study period, 320 patients with a total of 365 episodes of <i>Candida</i> BSIs were identified and analyzed. Mixed <i>Candida</i>/bacterial BSIs were 35 episodes (9.6%). No significant difference was found between mixed <i>Candida</i>/bacterial BSIs and monomicrobial <i>Candida</i> BSIs in terms of patient demographics, <i>Candida</i> species distributions, most chronic comorbidities or risk factors. Patients with mixed <i>Candida</i>/bacterial BSIs were associated with a significantly higher risk of subsequent bacteremia (51.4% vs. 21.2%, <i>p</i> < 0.001) and a relatively higher candidemia-attributable mortality rate (37.2% vs. 22.4%, <i>p</i> = 0.061) than those with monomicrobial <i>Candida</i> BSIs. Mixed <i>Candida</i>/bacterial BSIs were not an independent risk factor of treatment failure or final mortality according to multivariate logistic regression analyses. <b>Conclusions:</b> The clinical significance of mixed <i>Candida</i>/bacterial BSIs in children included a longer duration of septic symptoms, significantly higher likelihood to have subsequent bacteremia, and relatively higher risk of candidemia attributable mortality.
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