title: Usefulness of the "Candida score" for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study.
abstract: OBJECTIVE
  To assess the usefulness of the "Candida score" (CS) for discriminating between Candida species colonization and invasive candidiasis (IC) in non-neutropenic critically ill patients. A rate of IC <5% in patients with CS <3 was the primary end point.
  
  
  METHODS
  Prospective, cohort, observational study.
  
  
  METHODS
  Thirty-six medical-surgical intensive care units of Spain, Argentina, and France.
  
  
  METHODS
  A total of 1,107 non-neutropenic adult intensive care unit patients admitted for at least 7 days between April 2006 and June 2007.
  
  
  RESULTS
  Clinical data, surveillance cultures for fungal growth, and serum levels of (1-3)-beta-d-glucan and anti-Candida antibodies (in a subset of patients) were recorded. The CS was calculated as follows (variables coded as absent = 0, present = 1): total parenteral nutrition x1, plus surgery x1, plus multifocal Candida colonization x1, plus severe sepsis x2. A CS >or=3 accurately selected patients at high risk for IC. The colonization index was registered if >or=0.5. The rate of IC was 2.3% (95% confidence interval [CI] 1.06-3.54) among patients with CS <3, with a linear association between increasing values of CS and IC rate (p <or= 0.001). The area under the receiver operating characteristic curve for CS was 0.774 (95% CI 0.715-0.832) compared with 0.633 (95% CI 0.557-0.709) for CI. (1-3)-Beta-d-glucan was also an independent predictor of IC (odds ratio 1.004, 95% CI 1.0-1.007). The relative risk for developing IC in colonized patients without antifungal treatment was 6.83 (95% CI 3.81-12.45).
  
  
  CONCLUSIONS
  In this cohort of colonized patients staying >7 days, with a CS <3 and not receiving antifungal treatment, the rate of IC was <5%. Therefore, IC is highly improbable if a Candida-colonized non-neutropenic critically ill patient has a CS <3.
authors.affiliation: Intensive Care Unit (CL), Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain.
authors.forename: Cristóbal
authors.initials: C
authors.lastname: León
authors.forename: Sergio
authors.initials: S
authors.lastname: Ruiz-Santana
authors.forename: Pedro
authors.initials: P
authors.lastname: Saavedra
authors.forename: Beatriz
authors.initials: B
authors.lastname: Galván
authors.forename: Armando
authors.initials: A
authors.lastname: Blanco
authors.forename: Carmen
authors.initials: C
authors.lastname: Castro
authors.forename: Carina
authors.initials: C
authors.lastname: Balasini
authors.forename: Aránzazu
authors.initials: A
authors.lastname: Utande-Vázquez
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: González de Molina
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Blasco-Navalproto
authors.forename: Maria J
authors.initials: MJ
authors.lastname: López
authors.forename: Pierre Emmanuel
authors.initials: PE
authors.lastname: Charles
authors.forename: Estrella
authors.initials: E
authors.lastname: Martín
authors.forename: María Adela
authors.initials: MA
authors.lastname: Hernández-Viera