Usefulness of the "Candida score" for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study.
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.
León
Cristóbal
C
Intensive Care Unit (CL), Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain.
Ruiz-Santana
Sergio
S
Saavedra
Pedro
P
Galván
Beatriz
B
Blanco
Armando
A
Castro
Carmen
C
Balasini
Carina
C
Utande-Vázquez
Aránzazu
A
González de Molina
Francisco J
FJ
Blasco-Navalproto
Miguel A
MA
López
Maria J
MJ
Charles
Pierre Emmanuel
PE
Martín
Estrella
E
Hernández-Viera
María Adela
MA