Usefulness of the "Candida score" for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study

• Published in: Critical care medicine Vol. 37; no. 5; p. 1624
• Main Authors: León, Cristóbal, Ruiz-Santana, Sergio, Saavedra, Pedro, Galván, Beatriz, Blanco, Armando, Castro, Carmen, Balasini, Carina, Utande-Vázquez, Aránzazu, González de Molina, Francisco J, Blasco-Navalproto, Miguel A, López, Maria J, Charles, Pierre Emmanuel, Martín, Estrella, Hernández-Viera, María Adela
• Format: Journal Article
• Language: English
• Published: United States 01.05.2009
• Subjects: Antifungal Agents - administration & dosage; Candida albicans - drug effects; Candida albicans - growth & development; Candidiasis - diagnosis; Candidiasis - drug therapy; Candidiasis - mortality; Cohort Studies; Colony Count, Microbial; Critical Care - methods; Critical Illness - mortality; Critical Illness - therapy; Female; Fungemia - diagnosis; Fungemia - drug therapy; Fungemia - mortality; Hospital Mortality - trends; Humans; Immunocompetence; Intensive Care Units; Male; Prospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Survival Analysis
• ISSN: 1530-0293
• DOI: 10.1097/ccm.0b013e31819daa14

To assess the usefulness of the "Candida score" (CS) for discriminating between Candida species colonization and invasive candidiasis (IC) in non-neutropenic critically ill patients. A rate of IC <5% in patients with CS <3 was the primary end point. Prospective, cohort, observational study. Thirty-six medical-surgical intensive care units of Spain, Argentina, and France. A total of 1,107 non-neutropenic adult intensive care unit patients admitted for at least 7 days between April 2006 and June 2007. Clinical data, surveillance cultures for fungal growth, and serum levels of (1-3)-beta-d-glucan and anti-Candida antibodies (in a subset of patients) were recorded. The CS was calculated as follows (variables coded as absent = 0, present = 1): total parenteral nutrition x1, plus surgery x1, plus multifocal Candida colonization x1, plus severe sepsis x2. A CS >or=3 accurately selected patients at high risk for IC. The colonization index was registered if >or=0.5. The rate of IC was 2.3% (95% confidence interval [CI] 1.06-3.54) among patients with CS <3, with a linear association between increasing values of CS and IC rate (p <or= 0.001). The area under the receiver operating characteristic curve for CS was 0.774 (95% CI 0.715-0.832) compared with 0.633 (95% CI 0.557-0.709) for CI. (1-3)-Beta-d-glucan was also an independent predictor of IC (odds ratio 1.004, 95% CI 1.0-1.007). The relative risk for developing IC in colonized patients without antifungal treatment was 6.83 (95% CI 3.81-12.45). In this cohort of colonized patients staying >7 days, with a CS <3 and not receiving antifungal treatment, the rate of IC was <5%. Therefore, IC is highly improbable if a Candida-colonized non-neutropenic critically ill patient has a CS <3.