title: 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.
authors.affiliation: University of Texas Health Science Center at Houston, 6431 Fannin, MSB 2.112, Houston, TX 77030, USA. Luis.Ostrosky-Zeichner@uth.tmc.edu
authors.forename: L
authors.initials: L
authors.lastname: Ostrosky-Zeichner
authors.forename: C
authors.initials: C
authors.lastname: Sable
authors.forename: J
authors.initials: J
authors.lastname: Sobel
authors.forename: B D
authors.initials: BD
authors.lastname: Alexander
authors.forename: G
authors.initials: G
authors.lastname: Donowitz
authors.forename: V
authors.initials: V
authors.lastname: Kan
authors.forename: C A
authors.initials: CA
authors.lastname: Kauffman
authors.forename: D
authors.initials: D
authors.lastname: Kett
authors.forename: R A
authors.initials: RA
authors.lastname: Larsen
authors.forename: V
authors.initials: V
authors.lastname: Morrison
authors.forename: M
authors.initials: M
authors.lastname: Nucci
authors.forename: P G
authors.initials: PG
authors.lastname: Pappas
authors.forename: M E
authors.initials: ME
authors.lastname: Bradley
authors.forename: S
authors.initials: S
authors.lastname: Major
authors.forename: L
authors.initials: L
authors.lastname: Zimmer
authors.forename: D
authors.initials: D
authors.lastname: Wallace
authors.forename: W E
authors.initials: WE
authors.lastname: Dismukes
authors.forename: J H
authors.initials: JH
authors.lastname: Rex
mesh_terms: 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