Citation Information :
Baronia A K, Yadav R, Marak RS, Singh R. External validation of risk prediction scores for invasive candidiasis in a medical/surgical intensive care unit: An observational study. Indian J Crit Care Med 2017; 21 (8):514-520.
Background: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis.
Methods: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis.
Results: Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%–47%, along with negative predictive values (NPVs) in the range of 84%–96% in the subgroup analysis.
Conclusion: Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy.
Brusselaers N, Blot S, Vogelaers D. Deep-seated Candida infections in the Intensive Care Unit. Neth J Crit Care 2011;15:184-90.
Clancy CJ, Nguyen MH. Finding the “missing 50%” of invasive candidiasis: How nonculture diagnostics will improve understanding of disease spectrum and transform patient care. Clin Infect Dis 2013;56:1284-92.
Kullberg BJ, Arendrup MC. Invasive candidiasis. N Engl J Med 2015;373:1445-56.
Morrell M, Fraser VJ, Kollef MH. Delaying the empiric treatment of Candida bloodstream infection until positive blood culture results are obtained: A potential risk factor for hospital mortality. Antimicrob Agents Chemother 2005;49:3640-5.
Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, et al. Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: A multi-institutional study. Clin Infect Dis 2006;43:25-31.
Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D, et al. Risk factors for invasive fungal disease in critically ill adult patients: A systematic review. Crit Care 2011;15:R287.
Eggimann P, Pittet D. Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later. Intensive Care Med 2014;40:1429-48.
Ahmed A, Azim A, Baronia AK, Marak KR, Gurjar M. Risk prediction for invasive candidiasis. Indian J Crit Care Med 2014;18:682-8.
León C, Ruiz-Santana S, Saavedra P, Almirante B, Nolla-Salas J, Alvarez-Lerma F, et al. A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 2006;34:730-7.
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994;220:751-8.
Ostrosky-Zeichner L, Pappas PG, Shoham S, Reboli A, Barron MA, Sims C, et al. Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the Intensive Care Unit. Mycoses 2011;54:46-51.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813-21.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Intensive Care Med 2003;29:530-8.
Playford EG, Lipman J, Kabir M, McBryde ES, Nimmo GR, Lau A, et al. Assessment of clinical risk predictive rules for invasive candidiasis in a prospective multicentre cohort of ICU patients. Intensive Care Med 2009;35:2141-5.
Hermsen ED, Zapapas MK, Maiefski M, Rupp ME, Freifeld AG, Kalil AC, et al. Validation and comparison of clinical prediction rules for invasive candidiasis in Intensive Care Unit patients: A matched case-control study. Crit Care 2011;15:R198.
Hall AM, Poole LA, Renton B, Wozniak A, Fisher M, Neal T, et al. Prediction of invasive candidal infection in critically ill patients with severe acute pancreatitis. Crit Care 2013;17:R49.
León C, Ruiz-Santana S, Saavedra P, Galván B, Blanco A, Castro C, et al. Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: A prospective multicenter study. Crit Care Med 2009;37:1624-33.
Posteraro B, De Pascale G, Tumbarello M, Torelli R, Pennisi MA, Bello G, et al. Early diagnosis of candidemia in Intensive Care Unit patients with sepsis: A prospective comparison of (1→3)-ß-D-glucan assay, Candida score, and colonization index. Crit Care 2011;15:R249.
Lau AF, Kabir M, Chen SC, Playford EG, Marriott DJ, Jones M, et al. Candida colonization as a risk marker for invasive candidiasis in mixed medical-surgical Intensive Care Units: Development and evaluation of a simple, standard protocol. J Clin Microbiol 2015;53:1324-30.