Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting

Abstract

The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1-3) OR presence of a central venous catheter (days 1-3) AND at least TWO of the following-total parenteral nutrition (days 1-3), any dialysis (days 1-3), any major surgery (days -7-0), pancreatitis (days -7-0), any use of steroids (days -7-3), or use of other immunosuppressive agents (days -7-0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…In agreement with previous studies, the Candida score was significantly higher in patients with IC than in the remaining groups, but the usefulness of this prediction rule is limited in patients undergoing abdominal surgery because in these circumstances the score is consistently higher than the discriminating cutoff point of at least 3. The CART analysis showed a very high negative predictive value, which is in agreement with data obtained by Ostrosky-Zeichner et al [3] with their prediction rule as well as with the CS in our two previous studies [2,4]. However, the CART positive predictive value was 42.4 %, which is clearly higher than 9 % obtained by the prediction rule of Ostrosky-Zeichner et al [3] and 13.8 % with CS in our previous study [4].…”

“…The CART analysis showed a very high negative predictive value, which is in agreement with data obtained by Ostrosky-Zeichner et al [3] with their prediction rule as well as with the CS in our two previous studies [2,4]. However, the CART positive predictive value was 42.4 %, which is clearly higher than 9 % obtained by the prediction rule of Ostrosky-Zeichner et al [3] and 13.8 % with CS in our previous study [4].…”

“…Clinical prediction rules are relevant elements enabling proper diagnosis but some of them are not easy to fulfill, have not been previously validated, or may be eventually unhelpful in patients having abdominal surgery (e.g., the Candida score) [2][3][4][5]. Specific antigen components of the fungal cell wall have been exploited for the development of diagnostic assays that can detect the presence of these components in the serum.…”

Evaluación del rendimiento de 1,3-β-d-glucano como apoyo diagnóstico de infecciones invasoras por Candida spp. en pacientes críticos adultos

“…En cuanto a otras candidiasis invasoras, los cultivos de diferentes muestras, aunque resulten positivos, conllevan en algunos casos la dificultad de diferenciar si constituyen infección o colonización. La evaluación de los factores de riesgo 2,4,23 , colonización 25 , el uso de sistema de puntaje como Candidascore 20,26 , o las reglas predictoras 27,28 sirven de orientación para focalizar la sospecha clínica en grupos de pacientes, pero el problema diagnóstico persiste. En este contexto, la incorporación de bio-marcadores significa una oportunidad de mejorar la capacidad diagnóstica y en consecuencia el inicio de la terapia antifúngica en ausencia de confirmación microbiológica.…”

Treatment of Candida Glabrata With Micafungin: A Case Report and Brief Review of the Literature

“…The risk factors for invasive candidiasis include antibiotic use and duration, more than 4 days on intensive care or longer than 48 hours on mechanical ventilation, high APACHE II score, abdominal surgery, total parenteral nutrition (TPN), central venous catheter (CVC) in situ, and concomitant infection [1,2]. Around 60% of patients will have one or more of these risk factors [3].…”