Candida Score Research Articles

Case report 5: Intensive care unit patient assessed using the Candida Score

Case report 5: Intensive care unit patient assessed using the Candida Score

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

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

Serum procalcitonin levels in critically ill patients colonized with Candida spp: new clues for the early recognition of invasive candidiasis?

Invasive candidiasis (IC) outcomes in intensive care units (ICUs) could be improved by the early administration of antifungals. The Candida Score (CS) prediction rule has been proposed for the selection of patients who could develop IC. Procalcitonin (PCT) levels allow prompt identification of sepsis, but their behavior in the setting of IC is unclear. We hypothesize that PCT could be helpful in the early diagnosis of IC in patients with Candida sp. colonization. Prospective observational study. Thirty-six ICUs in Spain, Portugal and France. Every non-neutropenic critically ill patient hospitalized for more than 7 days without concurrent bacterial infection. The CS was calculated weekly. Serums were collected concomitantly. Two hundred twenty PCT levels were measured in 136 patients [neither colonized nor infected (NCNI): n = 73; multifocal colonization (MF): n = 43; MF + IC: n = 20]. Baseline PCT levels were significantly higher in the MF + IC group than in other groups (p = 0.001). In patients with MF, the highest CS value calculated during the patient's stay was the sole independent predictor of IC. The receiver-operating curve analysis showed that the diagnosis values of PCT and CS were comparable (AUROCC = 0.713, and 0.727, respectively). Moreover, PCT increased the positive predictive value of CS from 44.7 to 59.3%. After 7 days of hospitalization, PCT levels in patients with MF who go on to develop IC are higher than in others. Serum PCT could also improve the predictive value of CS. PCT together with CS could therefore be considered for the assessment of IC risk.

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

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.

Assessing the Risk for Invasive Candidiasis in the ICU

Invasive fungal infections in critically ill patients are worrisome because diagnosis is difficult and the mortality rate is high. Researchers recently developed a “ Candida score” (CS) to assess the risk for invasive candidiasis (IC) in such patients. The score was calculated by assigning one point each for total parenteral nutrition, surgery, and multifocal Candida colonization and two points for severe sepsis. Now, the …

¿Implica el aislamiento de Candida spp. en muestras intraabdominales de pacientes críticos la necesidad de tratamiento antifúngico?

The diagnostic and therapeutic approaches to IFI have changed significantly in recent years, fostered by the introduction of new diagnostic methods and new antifungal products. The diagnosis of invasive candidiasis (IC) involves both clinical and laboratory parameters, but neither of these are specific and the majority of the yeast isolated showed only colonization but not true infection. This situation occurs in critical care setting especially when surgical drainages are used. A substantial number of patients become colonized with Candida spp. after abdominal surgery, but only a minority subsequently develops invasive candidiasis. The clinical and microbiological diagnosis of Candida peritonitis remains problematic. It is still unclear which patients with may benefit from antifungal treatment. Antifungal therapy can be suggested in critically ill patients with peritonitis where Candida is diagnosed based on perioperatively sampled peritoneal fluid. Since fungal infection is also a relatively common complication of severe pancreatitis it seems reasonable that fungal prophylaxis may be an important component of management although actually there is no evidence to support this approach. However, the high mortality associated with IC is partly correlated to the difficulties of making an early diagnosis, thus, to improve earlier diagnosis and survival of IC, new nonculture-based microbiological tools such as Candida albicans germ tube antibodies (CAGTA) and/or polymerase chain reaction (PCR) techniques for the detection of fungal-specific DNA should be used in conjunction with recent published "Candida score" prediction rule. An algorithm based on this approach has been provided to assess early treatment in surgical patients with yeasts isolated from intra-abdominal samples.

Management of invasive Candida infections in non-neutropenic critically ill patients: from prophylaxis to early therapy

Echinocandins are the treatment of choice for patients with severe forms of candidaemia, including neutropenic patients and those episodes presenting with shock. There is little distinction between the three available echinocandins (caspofungin, anidulafungin and micafungin), but there is more clinical experience with caspofungin. Identifying patients who will benefit from early antifungal therapy using clinical tools such as the ‘ Candida Score' is an interesting strategy that may reduce the high mortality in critically ill patients with invasive fungal infections.

A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization

A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization

Application of a new Candida score for early antifungal treatment in an adult medical – surgical critical care unit

The incidence of infections caused by Candida species in critical care has substantially increased in recent years. Recently, Candida infections have been increasing especially in critical care patients. Invasive candidiasis has been associated with severe sepsis, septic shock and multiple organ failure. With a clinical scenario very similar to bacterial infections, this infection is a diagnostic challenge with an estimated mortality rate of 40%.

A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization*

To obtain a score for deciding early antifungal treatment when candidal infection is suspected in nonneutropenic critically ill patients. Analysis of data collected from the database of the EPCAN project, an ongoing prospective, cohort, observational, multicenter surveillance study of fungal infection and colonization in intensive care unit (ICU) patients. Seventy-three medical-surgical ICUs of 70 teaching hospitals in Spain. A total of 1,699 ICU patients aged 18 yrs and older admitted for at least 7 days between May 1998 and January 1999 were studied. Surveillance cultures of urine, tracheal, and gastric samples were obtained weekly. Patients were grouped as follows: neither colonized nor infected (n=719), unifocal or multifocal Candida colonization (n=883), and proven candidal infection (n=97). The odds ratio (OR) for each risk factor associated with colonization vs. proven candidal infection was estimated. A logistic regression model was performed to adjust for possible confounders. The "Candida score" was obtained according to the logit method. The discriminatory power was evaluated by the area under the receiver operating characteristics curve. In the logit model, surgery (OR=2.71, 95% confidence interval [CI], 1.45-5.06); multifocal colonization (OR=3.04, 95% CI, 1.45-6.39); total parenteral nutrition (OR=2.48, 95% CI, 1.16-5.31); and severe sepsis (OR=7.68, 95% CI, 4.14-14.22) were predictors of proven candidal infection. The "Candida score" for a cut-off value of 2.5 (sensitivity 81%, specificity 74%) was as follows: parenteral nutrition, +0.908; surgery, +0.997; multifocal colonization, +1.112; and severe sepsis, +2.038. Central venous catheters were not a significant risk factor for proven candidal infection (p=.292). In a large cohort of nonneutropenic critically ill patients in whom Candida colonization was prospectively assessed, a "Candida score">2.5 accurately selected patients who would benefit from early antifungal treatment.