title: The Utility of the Candida Score in Patients With Sepsis.
abstract: BACKGROUND
  Candida is a leading cause of infection in the intensive care unit. Colonization versus infection remains a challenge. A Candida Score (CS) of 3 or greater has been used to target antifungal therapy in surgical patients at risk of candidemia but has not been well evaluated in medical patients with sepsis.
  
  
  OBJECTIVE
  The aim of this study was to assess utility of the CS in detecting candidemia early in patients with sepsis.
  
  
  METHODS
  This was a secondary analysis of patients with sepsis (n = 77) who were followed up for development of new infections. Patients with known fungal infection at admission were excluded. Candida colonization was defined as Candida cultured from any baseline culture, except blood, as a part of routine clinical care.
  
  
  RESULTS
  Candidemia was detected in 8 of 77 participants (10.4%; 4 [15.4%] with a CS ≥3 and 4 [7.8%] with a CS <3). Demographic variables (age, race, sex) were similar among those who did and did not develop candidemia. Using the recommended CS of 3 or greater, sensitivity was (4/8) 50%, specificity was (47/69) 68.1%, positive predictive value was (4/26) 15.4%, and negative predictive value was (47/51) 92.2%. Baseline colonization was significantly higher among those who developed candidemia (50% vs 11.6%; P = .02), but no significant differences were observed among CS components or total scores.
  
  
  CONCLUSIONS
  Despite a relatively poor sensitivity, a reasonable specificity with a strong negative predictive value makes this tool a viable option for screening medically ill patients who may require antifungal agents. The CS should be evaluated in a larger, more inclusive, medical population.
authors.affiliation: Reba Umberger, PhD, RN, CCRN-K, is assistant professor at the College of Nursing, The University of Tennessee, Knoxville, and research associate at the Veterans Affairs Medical Center, Memphis, Tennessee. Kristen Garsee, BSN, RN, CCRN, is a student at the College of Nursing, The University of Tennessee, Knoxville. Brent Davidson, BSN, RN, CCRN, is a student at the College of Nursing, The University of Tennessee, Knoxville. Jessica Alston Carringer, MSN, FNP-BC, is a hematology oncology nurse practitioner, Hanna Cancer Associates, Knoxville, Tennessee. David Kuhl, PharmD, is a professor of pharmacy, School of Pharmacy, Union University, Jackson, Tennessee. Muthiah P. Muthiah, MD, is the director of the Medical Intensive Care Unit, Veterans Affairs Medical Center, and associate professor in the Division of Pulmonary, Critical Care, and Sleep Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Reba
authors.initials: R
authors.lastname: Umberger
authors.forename: Kristen
authors.initials: K
authors.lastname: Garsee
authors.forename: Brent
authors.initials: B
authors.lastname: Davidson
authors.forename: Jessica Alston
authors.initials: JA
authors.lastname: Carringer
authors.forename: David
authors.initials: D
authors.lastname: Kuhl
authors.forename: Muthiah P
authors.initials: MP
authors.lastname: Muthiah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents; D002175:Candida / Q000302:isolation & purification*; D058387:Candidemia; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D018805:Sepsis / Q000150:complications*
chemical_list: D000935:Antifungal Agents