Predicting invasive fungal disease due to Candida species in non-neutropenic, critically ill, adult patients in United Kingdom critical care units

Abstract

BackgroundGiven the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis.MethodsData on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the Fungal Infection Risk Evaluation (FIRE) Study. Three risk prediction models were developed to model the risk of subsequent Candida IFD based on information available at three time points: admission to the critical care unit, at the end of 24 h and at the end of calendar day 3 of the critical care unit stay. The final model at each time point was evaluated in the three external validation samples.ResultsBetween July 2009 and April 2011, 60,778 admissions from 96 critical care units were recruited. In total, 359 admissions (0.6 %) were admitted with, or developed, Candida IFD (66 % Candida albicans). At the rate of candidaemia of 3.3 per 1000 admissions, blood was the most common Candida IFD infection site. Of the initial 46 potential variables, the final admission model and the 24-h model both contained seven variables while the end of calendar day 3 model contained five variables. The end of calendar day 3 model performed the best with a c index of 0.709 in the full validation sample.ConclusionsIncidence of Candida IFD in UK critical care units in this study was consistent with reports from other European epidemiological studies, but lower than that suggested by previous hospital-wide surveillance in the UK during the 1990s. Risk modeling using classical statistical methods produced relatively simple risk models, and associated clinical decision rules, that provided acceptable discrimination for identifying patients at ‘high risk’ of Candida IFD.Trial registrationThe FIRE Study was reviewed and approved by the Bolton NHS Research Ethics Committee (reference: 08/H1009/85), the Scotland A Research Ethics Committee (reference: 09/MRE00/76) and the National Information Governance Board (approval number: PIAG 2-10(f)/2005).Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1803-9) contains supplementary material, which is available to authorized users.

Fungal infections in adult patients on extracorporeal life support

“…In recent large multicentric cohort studies of unselected patients admitted to mixed ICUs, the prevalence of candidemia ranged from 0.33% to 0.69% [ 3 , 34 ]. Although the rate we found was higher than the one reported in these large studies, in a cohort of patients with severe critical illness and a long ICU length of stay, we expected a much higher rate.…”

“…León and colleagues found an overall survival of 43.4% in critically ill patients with invasive Candida infection hospitalized for more than 7 days [ 19 ]. Others have even found a survival of 57–60% in general ICU cohorts [ 3 , 34 ]. Patients on ECMO could simply have a higher illness severity than these cohorts.…”

Advances in the Diagnosis and Management of Invasive Fungal Disease

“…2 Early institution of effective treatment is critical to reduce mortality, and differentiating between invasive disease and colonization is essential to avoiding toxicities in patients at risk for multiorgan dysfunction. To this end, multiple riskscoring models ( Table 2) [7][8][9][10][11][12] have been devised to better predict which ICU patients are more likely to have or develop IFD.…”

Avaliação das atividades antifúngica, antimicobacteriana e larvicida de Duroia macrophylla e D. saccifera

“…33 Apesar das espécies "não-albicans" serem menos invasivas e virulentas, têm mostrado menor susceptibilidades aos antifúngicos. 34 Neste estudo, o padrão de sensibilidade das três espécies de Candida sp. testadas foi semelhante ao padrão descrito para os antifúngicos, sendo C. albicans > C. glabrata > C. parapsilosis.…”