Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting.
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.
Ostrosky-Zeichner
L
L
University of Texas Health Science Center at Houston, 6431 Fannin, MSB 2.112, Houston, TX 77030, USA. Luis.Ostrosky-Zeichner@uth.tmc.edu
Sable
C
C
Sobel
J
J
Alexander
B D
BD
Donowitz
G
G
Kan
V
V
Kauffman
C A
CA
Kett
D
D
Larsen
R A
RA
Morrison
V
V
Nucci
M
M
Pappas
P G
PG
Bradley
M E
ME
Major
S
S
Zimmer
L
L
Wallace
D
D
Dismukes
W E
WE
Rex
J H
JH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002177:Candidiasis / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology