title: Evaluation of "Candida score" in critically ill patients: a prospective, multicenter, observational, cohort study.
abstract: BACKGROUND
  Although prompt initiation of appropriate antifungal therapy is essential for the control of invasive Candida infections and an improvement of prognosis, early diagnosis of invasive candidiasis remains a challenge and criteria for starting empirical antifungal therapy in ICU patients are poorly defined. Some scoring systems, such as the "Candida score" could help physicians to differentiate patients who could benefit from early antifungal treatment from those for whom invasive candidiasis is highly improbable. This study evaluated the performance of this score in a cohort of critically ill patients.
  
  
  METHODS
  A prospective, observational, multicenter, cohort study was conducted from January 2010 to March 2011 in five intensive care units in Nord-Pas de Calais, an area from North of France. All patients exhibiting, on ICU admission or during their ICU stay, a hospital-acquired severe sepsis or septic shock could be included in this study. The data collected included patient characteristics on ICU admission and at the onset of severe sepsis or septic shock. The "Candida score" was calculated at the onset of sepsis or shock. The incidence of invasive candidiasis was determined and its relationship with the value of the "Candida score" was studied.
  
  
  RESULTS
  Ninety-four patients were studied. When severe sepsis or shock occurred, 44 patients had a score = 2, 29 patients had a score = 3, 17 patients had a score = 4, and 4 patients had a score = 5. Invasive candidiasis was observed in five (5.3%) patients. One patient had candidemia, three patients had peritonitis, and one patient had pleural infection. The rates of invasive candidiasis was 0% in patients with score = 2 or 3, 17.6% in patients with score = 4, and 50% in patients with score = 5 (p < 0.0001).
  
  
  CONCLUSIONS
  Our results confirm that the "Candida score" is an interesting tool to differentiate among ICU patients who exhibit hospital-acquired severe sepsis or septic shock those would benefit from early antifungal treatment (score > 3) from those for whom invasive candidiasis is highly improbable (score ≤ 3).
authors: Service de Réanimation Médicale et Maladies Infectieuses, Centre Hospitalier de Tourcoing, 59208 Tourcoing, France. oleroy@ch-tourcoing.fr.
authors: Guillaume
authors: G
authors: Leroy
authors: Fabien
authors: F
authors: Lambiotte
authors: Didier
authors: D
authors: Thévenin
authors: Christian
authors: C
authors: Lemaire
authors: Erika
authors: E
authors: Parmentier
authors: Patrick
authors: P
authors: Devos
authors: Olivier
authors: O
authors: Leroy