title: A simple prediction score for estimating the risk of candidaemia caused by fluconazole non-susceptible strains.
abstract: We aimed to develop a simple prediction score to identify fluconazole non-susceptible (Flu-NS) candidaemia using simple clinical criteria. A derivation cohort was extracted from the CANDIPOP study, a prospective, multicentre, population-based surveillance programme on candidaemia conducted in 29 hospitals in Spain from April 2010 to May 2011. The score was validated with an external, multicentre cohort of adults with candidaemia in six tertiary hospitals in three countries. The prediction score was based on three variables selected by a logistic regression model together with the severity of disease. In total, 617 and 297 cases of candidaemia were included in the derivation and validation cohorts, respectively; of these, 134 (21.7%) and 57 (19.2%) were caused by Flu-NS strains. Factors independently associated with Flu-NS were transplant recipient status (adjusted odds ratio (AOR) 2.13; 95% CI 1.01-4.55; p 0.047), hospitalization in a unit with a high prevalence (≥ 15%) of Flu-NS strains (7.53; 4.68-12.10; p < 0.001), and previous azole therapy for at least 3 days (2.04; 1.16-3.62; p 0.014). The area under the receiver operating characteristics curve (AUC) was 0.76 (0.72-0.81), and using 2 points as the Flu-NS prediction score cut-off gave a sensitivity of 82.1%, a specificity of 65.6%, and a negative predictive value of 93%. The AUC in the validation cohort was 0.72 (95% CI 0.65-0.79). Hence, the Flu-NS prediction score helped to exclude Flu-NS Candida strains. This could improve the selection of empirical treatments for candidaemia in the future.
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Cuervo
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Puig-Asensio
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain. Electronic address: carolgv75@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Garcia-Vidal
authors.affiliation: Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Fernández-Ruiz
authors.affiliation: Hospital Universitari "La Fe", Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pemán
authors.affiliation: University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Nucci
authors.affiliation: Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (i+12), Madrid, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Aguado
authors.affiliation: Hospital Universitari "La Fe", Valencia, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Salavert
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: González-Romo
authors.affiliation: Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Guinea
authors.affiliation: Department of Mycology, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Zaragoza
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gudiol
authors.affiliation: Hospital Universitari de Bellvitge, IDIBELL (Institut D'investigació Biomèdica de Bellvitge), Universitat de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Carratalà
authors.affiliation: Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Almirante
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology*; D002175:Candida / Q000187:drug effects*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology; D003661:Decision Support Techniques; D005260:Female; D015725:Fluconazole / Q000494:pharmacology*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D015725:Fluconazole
keywords: C. glabrata; Candidaemia; fluconazole non-susceptible; prediction score; treatment