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Previous studies have reported worse outcome for polymicrobial than for monomicrobial BSIs. We analyzed patient characteristics and temporal trends of the incidence and outcome of polymicrobial BSIs in Finland during 2004\u20132018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used data from national registries to identify polymicrobial BSIs during 2004\u20132018 and to determine origin of infection, patients\u2019 comorbidities and death within 30 days. Charlson comorbidity index (CCI) was calculated according to ICD-10 diagnose codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 173,715 BSIs were identified; 11,347 (6.5%) were polymicrobial. Compared with monomicrobial BSIs, the proportion of males, healthcare-associated BSIs, and patients with high CCI were greater in polymicrobial BSIs (58.5% vs. 51.5%, 34.7% vs. 28.7%, and 24.9% vs. 21.1%, respectively).\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      , enterococci, coagulase-negative staphylococci, and\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      sp. were the most common pathogens of polymicrobial BSIs. Anaerobic bacteria were noted in 16.3% of polymicrobial BSIs, compared with 4.3% of monomicrobial BSIs. The annual polymicrobial BSI incidence rose from 9.7 to 21.8\/100,000 population during 2004\u20132018, most sharply among patients aged\u2009\u2265\u200990 years. The 30-day case fatality of polymicrobial BSIs was 20.6%, significantly higher than in monomicrobial BSIs (12.4%), and a decline from 25.2 to 20.8% was observed over time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Polymicrobial BSI incidence increased twofold during 2004\u20132018. The case fatality was considerably higher in polymicrobial than in monomicrobial episodes, likely related to patients\u2019 older age and more severe comorbidity. Our findings emphasize the need for prompt recognition of patients at risk to guide the choice of empiric treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02642-5","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T13:13:40Z","timestamp":1758806020000},"page":"169-177","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Characteristics, incidence and outcome of polymicrobial bloodstream infections: a nationwide population-based study, Finland, 2004\u20132018"],"prefix":"10.1007","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9260-2305","authenticated-orcid":false,"given":"Keiju S.K.","family":"Kontula","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsi","family":"Skogberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka","family":"Ollgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asko","family":"J\u00e4rvinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Outi","family":"Lyytik\u00e4inen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"2642_CR1","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1001\/archinte.167.8.834","volume":"167","author":"DZ Uslan","year":"2007","unstructured":"Uslan DZ, Crane SJ, Steckelberg JM, Cockerill FR III, St Sauver JL, Wilson WR, et al. 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THL\/1349\/6.02.00\/2019).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Analyses were performed on anonymized surveillance data; patient informed consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"KK, JO and OL report no conflict of interest relevant to the content of this article. KS has received a speaker honorarium form Pfizer and travel support from AstraZeneca. AJ has received speaker honoraria from AstraZeneca, Tillotts Pharma, and Shionogi and consultant honoraria from AstraZeneca, BioM\u00e9rieux, GlaxoSmithKline, and Nordic Infucare. AJ received travel support from Gilead Sciences.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}