Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit.
We created a clinical prediction rule to identify patients at risk of invasive candidiasis (IC) in the intensive care unit (ICU) (Eur J Clin Microbiol Infect Dis 2007; 26:271). The rule applies to <10% of patients in ICUs. We sought to create a more inclusive rule for clinical trials. Retrospective review of patients admitted to ICU ≥ 4 days, collecting risk factors and outcomes. Variations of the rule based on introduction of mechanical ventilation and risk factors were assessed. We reviewed 597 patients with a mean APACHE II score of 14.4, mean ICU stay of 12.5 days and mean ventilation time of 10.7 days. A variation of the rule requiring mechanical ventilation AND central venous catheter AND broad spectrum antibiotics on days 1-3 AND an additional risk factor applied to 18% of patients, maintaining the incidence of IC at 10%. Modification of our original rule resulted in a more inclusive rule for studies.
Ostrosky-Zeichner
Luis
L
Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX 77030, USA. uis.ostrosky-zeichner@uth.tmc.edu
Pappas
Peter G
PG
Shoham
Shmuel
S
Reboli
Annette
A
Barron
Michelle A
MA
Sims
Charles
C
Wood
Craig
C
Sobel
Jack D
JD
D018806:APACHE; D000935:Antifungal Agents / Q000627:therapeutic use*; D058365:Candidiasis, Invasive / Q000188:drug therapy* / Q000517:prevention & control*; D018890:Chemoprevention / Q000379:methods*; D002986:Clinical Trials as Topic; D003428:Cross Infection / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D012189:Retrospective Studies; D016896:Treatment Outcome
D000935:Antifungal Agents