Abstract
IntroductionOver 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units. Invasive fungal disease (IFD) in critically ill patients is associated with increased morbidity and mortality at a cost to both the individual and the National Health Service. In this paper, we report the results of a systematic review performed to identify and summarise the important risk factors derived from published multivariable analyses, risk prediction models and clinical decision rules for IFD in critically ill adult patients to inform the primary data collection for the Fungal Infection Risk Evaluation Study.MethodsAn internet search was performed to identify articles which investigated risk factors, risk prediction models or clinical decisions rules for IFD in critically ill adult patients. Eligible articles were identified in a staged process and were assessed by two investigators independently. The methodological quality of the reporting of the eligible articles was assessed using a set of questions addressing both general and statistical methodologies.ResultsThirteen articles met the inclusion criteria, of which eight articles examined risk factors, four developed a risk prediction model or clinical decision rule and one evaluated a clinical decision rule. Studies varied in terms of objectives, risk factors, definitions and outcomes. The following risk factors were found in multiple studies to be significantly associated with IFD: surgery, total parenteral nutrition, fungal colonisation, renal replacement therapy, infection and/or sepsis, mechanical ventilation, diabetes, and Acute Physiology and Chronic Health Evaluation II (APACHE II) or APACHE III score. Several other risk factors were also found to be statistically significant in single studies only. Risk factor selection process and modelling strategy also varied across studies, and sample sizes were inadequate for obtaining reliable estimates.ConclusionsThis review shows a number of risk factors to be significantly associated with the development of IFD in critically ill adults. Methodological limitations were identified in the design and conduct of studies in this area, and caution should be used in their interpretation.
Highlights
Over 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units
This paper reports the results of a systematic review performed to identify and summarise the important risk factors from published multivariable analyses, risk prediction models and clinical decision rules for Invasive fungal disease (IFD) in critically ill adult patients to inform the primary data collection in the Fungal Infection Risk Evaluation (FIRE) Study
Abstracts and full texts of those potentially eligible were assessed by two reviewers (HM and JS) independently and were included if the following criteria were met: (1) evaluation of multiple risk factors, a scoring system or a clinical decision rule for IFD in critically ill patients; (2) inclusion of a control group consisting of patients without IFD or any other systemic infection and (3) study of adult humans
Summary
Over 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units. Invasive fungal disease (IFD) in critically ill patients is associated with increased morbidity and mortality at a cost to both the individual and the National Health Service. All of the patient groups, were at high risk of IFD, with rates in the control arms typically being over 10%. Despite this heterogeneity, the RCTs demonstrated a remarkably homogeneous effect of antifungal prophylaxis on the risk of proven IFD with a suggested reduction in all-cause mortality [17]. The question, is not whether antifungal prophylaxis is effective, but rather how to select an appropriate group of high-risk patients to receive prophylaxis, as indiscriminate use of antifungal agents is likely to promote drug resistance and drive up cost
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