title: Candida Surveillance in Surgical Intensive Care Unit (SICU) in a Tertiary Institution.
abstract: BACKGROUND
  Colonization of patients occurs before development into invasive candidiasis. There is a need to determine the incidences of Candida colonization and infection in SICU patients, and evaluate the usefulness of beta-D-glucan (BDG) assay in diagnosing invasive candidiasis when patients are colonized.
  
  
  METHODS
  Clinical data and fungal surveillance cultures in 28 patients were recorded from November 2010, and January to February 2011. Susceptibilities of Candida isolates to fluconazole, voriconazole, amphotericin B, micafungin, caspofungin and anidulafungin were tested via Etest. The utilities of BDG, Candida score and colonization index for candidiasis diagnosis were compared via ROC.
  
  
  RESULTS
  30 BDG assays were performed in 28 patients. Four assay cases had concurrent colonization and infection; 23 had concurrent colonization and no infection; three had no concurrent colonization and infection. Of 136 surveillance swabs, 52 (38.24 %) were positive for Candida spp, with C. albicans being the commonest. Azole resistance was detected in C. albicans (7 %). C. glabrata and C. tropicalis were, respectively, 100 and 7 % SDD to fluconazole. All 3 tests showed high sensitivity of 75-100 % but poor specificity ranging 15.38-38.46 %. BDG performed the best (AUC of 0.89).
  
  
  CONCLUSIONS
  Despite that positive BDG is common in surgical patients with Candida spp colonization, BDG performed the best when compared to CI and CS.
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Block 8 Level 2, Outram Road, Singapore, 169608, Singapore. liew.yi.xin@sgh.com.sg.
authors.forename: Yi Xin
authors.initials: YX
authors.lastname: Liew
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Block 8 Level 2, Outram Road, Singapore, 169608, Singapore. jocelyn.teo.qi.min@sgh.com.sg.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Teo
authors.affiliation: Division of Nursing, Department of SICU, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. irene.too.a.l@sgh.com.sg.
authors.forename: Irene Ai-Ling
authors.initials: IA
authors.lastname: Too
authors.affiliation: Department of Pathology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. cecilia.ngan.c.l@sgh.com.sg.
authors.forename: Cecilia Cheng-Lai
authors.initials: CC
authors.lastname: Ngan
authors.affiliation: Department of Pathology, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. tan.ai.ling@sgh.com.sg.
authors.forename: Ai Ling
authors.initials: AL
authors.lastname: Tan
authors.affiliation: Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. piotr.chlebicki@sgh.com.sg.
authors.forename: Maciej Piotr
authors.initials: MP
authors.lastname: Chlebicki
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Block 8 Level 2, Outram Road, Singapore, 169608, Singapore. andrea.kwa.l.h@sgh.com.sg.|Emerging Infectious Diseases, Duke-National University of Singapore Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore. andrea.kwa.l.h@sgh.com.sg.|Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4A, Level 3, 18 Science Drive 4, Singapore, 117543, Singapore. andrea.kwa.l.h@sgh.com.sg.
authors.forename: Andrea Lay-Hoon
authors.initials: AL
authors.lastname: Kwa
authors.affiliation: Department of Pharmacy, Singapore General Hospital, Block 8 Level 2, Outram Road, Singapore, 169608, Singapore. winnie.lee.h.l@sgh.com.sg.
authors.forename: Winnie
authors.initials: W
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000666:Amphotericin B / Q000627:therapeutic use; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000627:therapeutic use; D002175:Candida / Q000302:isolation & purification* / Q000502:physiology; D002176:Candida albicans / Q000302:isolation & purification / Q000502:physiology; D041221:Candida glabrata / Q000302:isolation & purification / Q000502:physiology; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D058365:Candidiasis, Invasive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D000077336:Caspofungin; D003422:Critical Care; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D055666:Lipopeptides / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012846:Singapore / Q000453:epidemiology; D062606:Tertiary Care Centers; D065819:Voriconazole / Q000627:therapeutic use; D047071:beta-Glucans / Q000032:analysis
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D047071:beta-Glucans; D000666:Amphotericin B; D015725:Fluconazole; D000077612:Anidulafungin; D000077336:Caspofungin; D065819:Voriconazole; D000077551:Micafungin