Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria

Wang, Katie; Hsueh, Kevin; Kronen, Ryan; Lin, Chih-Lung; Salazar, Ana S.; Powderly, William G.; Spec, Andrej

doi:10.1111/myc.12917

Cited by 17 publications

(14 citation statements)

References 42 publications

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“…The Candida score by Leon et al [11] is the most common scoring tool to predict candidaemia in ICUs and has been externally validated with fair to good discrimination. However, the risk factors included in the multivariate analysis were determined first by univariate analysis, as in the works by Wang et al [29] and Cuervo et al [30]. This approach is incorrect, as a univariate model is less comprehensive and does not consider relationships between different factors, making the final model prone to serious confusion bias, inclusion of false positives and exclusion of false negatives.…”

Section: Discussionmentioning

confidence: 99%

A clinical predictive model of candidaemia by Candida auris in previously colonized critically ill patients

García-Bustos

Salavert

Ruiz-Gaitán

et al. 2020

Clinical Microbiology and Infection

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Objectives: Candida auris is an emerging multidrug-resistant fungus that has been associated with nosocomial outbreaks with high rates of mortality and transmission. The aim of this study was to perform a retrospective cohort analysis of risk factors and to build a scoring method for estimating the risk of candidaemia in colonized critically ill patients. Methods: We performed a retrospective observational cohort study of patients aged 15 years colonized by C. auris in the 3-year period between March 2016 and March 2019. Epidemiological, clinical, laboratory and microbiological data were collected. We developed a predictive model for candidaemia using elastic net multivariable logistic regression techniques, assessed its discriminative capacity, and internally validated it using bootstrap resampling. Results: Two-hundred and six patients were enrolled in the cohort for derivation and internal validation. Thirty-seven out of 206 patients developed candidaemia. Total parenteral nutrition was the foremost risk factor (adjusted OR 3.73); previous surgery (adjusted OR 1.03), sepsis (adjusted OR 1.75), previous exposure to antifungal agents (adjusted OR 1.17), arterial catheters (adjusted OR 1.46), central venous catheters (adjusted OR 1.21), presence of advanced chronic kidney disease (adjusted OR 1.35) and multifocal colonization (adjusted OR of unifocal colonization 0.46) were proven to be independent predictors of candidaemia in our cohort. The corresponding area under the curve (AUC) of the elastic net regularized predictive model was 0.89 (95%CI 0.826; 0.951). After performing the internal validation by generating 500 bootstrap replications, the model still showed great accuracy, with a resulting AUC of 0.84. Conclusion:Our study provides evidence on the independent predisposing factors for candidaemia. It may help predict its estimated risk and may identify a high-risk population that could benefit from early or prophylactic antifungal treatment after external validation in other cohorts.

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Section: Discussionmentioning

confidence: 99%

A clinical predictive model of candidaemia by Candida auris in previously colonized critically ill patients

García-Bustos

Salavert

Ruiz-Gaitán

et al. 2020

Clinical Microbiology and Infection

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“… 3 , 6 Candiduria is not only a marker for seriously ill patients that need particular attentions, but also an independent risk factor for invasive candidiasis (IC). 7 For example, the Infectious Diseases Association of America (IDSA) guidelines (2016 version) emphasized the importance of treatment for candiduria patients under high-risk candidiasis conditions. A molecular correlation between Candida strains isolated from candidemia and concomitant candiduria indicated that hematogenous dissemination possibly existed in ICU candiduria patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Novel Laboratory Candiduria Screening Protocol in the Intensive Care Unit

He¹,

Su²,

Bi³

et al. 2021

IDR

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Background: Since urine cultures are only guaranteed for patients with obvious urinary symptoms in most cases, most of candiduria episodes are ignored in clinic. Objective: This study aimed to design a screening protocol to improve diagnostic efficiency of candiduria, and provide information of Candida species and drug susceptibility. Methods: All patients, who were admitted to the intensive care unit (ICU) of our hospital during December 1, 2018 and October 1, 2019, were enrolled in this study. Urinalysis was performed every three days for each subject from the first day of ICU admission. Urine specimens were sampled for fungal culture with either condition: (1) yeast-like cell counting (YLCC) ≥200; (2) positive YLCCs were observed in two consecutive tests, and at least one YLCC ≥100. Results: The screening protocol dramatically improved the candiduria diagnostic rate of ICU patients from 2.28% to 17.27%. However, compared to the historical control, the screening protocol has no time-saving advantage in candiduria diagnosing. Higher percentage of C. albicans in screening protocol-identified candiduria patients was observed, although there was no statistical difference. Our results indicated that female gender, pneumonia, diabetes and infarction/hemorrhage patients were more prone to develop candiduria. Non-candiduria patients showed a better tendency for survival and shorter ICU stay length. Multisite colonization was common in the surveyed candiduria patients, who were up to 70.83% showed Candida positive cultures in sputum. Conclusion: The screening protocol established in the study was a convenient and practical tool for early warning and feasible management of candiduria and IC.

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“…К предрасполагающим факторам развития кандидемии на фоне кандидурии относят: стационарное лечение в течение 12 и более суток, наличие центрального венозного катетера, парентеральное питание, онкологическое заболевание тазовых органов и крови, лечение ингибиторами бета-лактамаз, почечную недостаточность, лихорадку, нейтропению, нейтрофилию, сахарный диабет, наличие гастростомы [42].…”

Section: факторы риска кандидоза мочевыводящих путейunclassified

Risk factors of the fungal urinary tract infections

2021

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The role of fungi as causative agents of infections is growing. In in-patients, especially at intensive care units, fungal infections might cause serious problems. Studies conducted over recent years shows an increase of fungi detection in urine in in-patients from 5,01 up to 10,63%. Most often, the appearance of fungi in the urine connected with contamination or colonization of the urinary tract. However, in immunocompromised patients, this could be the part of urinary tract infection and even of disseminated fungal process. Candida is the most common cause of fungal urinary tract infections. At the same time, the presence of Candida in urine (candiduria) not always comes with clinical signs of urethritis, cystitis and pyelonephritis. Detection of noCandida albicans agents in urine is increasing, new Candida species revealed are resistant to antifungal drugs so risk of complications is increasing. Recent researches reveal new mechanisms of how Candida interacts with the bacteria that cause urinary infections. The main mechanisms of Candida virulence factors are dimorphism, adhesion proteins — Als1-7,9 and Gls, invasion enzymes — phospholipase, Als3 and Ssa1, as well as enzymes that neutralize reactive oxygen species. The most significant risk factors of fungal urinary tract infection are the presence of a urinary catheter, diabetes mellitus, immunosuppression and previous antibiotic intake. The study of the formation process of the cellular and immune response to Candida makes it possible to identify the main links in the pathogenesis of urinary tract candidiasis, as well as the main role of immunosuppression in the development of the disease.

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Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria

Cited by 17 publications

References 42 publications

A clinical predictive model of candidaemia by Candida auris in previously colonized critically ill patients

A clinical predictive model of candidaemia by Candida auris in previously colonized critically ill patients

Evaluation of a Novel Laboratory Candiduria Screening Protocol in the Intensive Care Unit

Risk factors of the fungal urinary tract infections

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