title: Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later.
abstract: BACKGROUND
  For decades, clinicians dealing with immunocompromised and critically ill patients have perceived a link between Candida colonization and subsequent infection. However, the pathophysiological progression from colonization to infection was clearly established only through the formal description of the colonization index (CI) in critically ill patients. Unfortunately, the literature reflects intense confusion about the pathophysiology of invasive candidiasis and specific associated risk factors.
  
  
  METHODS
  We review the contribution of the CI in the field of Candida infection and its development in the 20 years following its original description in 1994. The development of the CI enabled an improved understanding of the pathogenesis of invasive candidiasis and the use of targeted empirical antifungal therapy in subgroups of patients at increased risk for infection.
  
  
  RESULTS
  The recognition of specific characteristics among underlying conditions, such as neutropenia, solid organ transplantation, and surgical and nonsurgical critical illness, has enabled the description of distinct epidemiological patterns in the development of invasive candidiasis.
  
  
  CONCLUSIONS
  Despite its limited bedside practicality and before confirmation of potentially more accurate predictors, such as specific biomarkers, the CI remains an important way to characterize the dynamics of colonization, which increases early in patients who develop invasive candidiasis.
authors.affiliation: Adult Critical Care Medicine and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland, philippe.eggimann@chuv.ch.
authors.forename: Philippe
authors.initials: P
authors.lastname: Eggimann
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D002176:Candida albicans / Q000187:drug effects / Q000254:growth & development* / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000503:physiopathology* / Q000517:prevention & control / Q000635:transmission; D058365:Candidiasis, Invasive / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control / Q000635:transmission; D018890:Chemoprevention; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000935:Antifungal Agents