Abstract
Purpose
To assess the generalisability of published clinical risk predictive models for invasive candidiasis in ICU patients.
Methods
The performance characteristics of published clinical risk factor-only and Candida colonisation-only predictive models for invasive candidiasis were assessed in a multicentre cohort of Australian ICU patients. Clinical risk factors and Candida colonisation parameters were collected prospectively from patients.
Results
The two clinical risk factor-only predictive models applied to an Australian patient cohort (n = 615) performed less well than in published studies involving derivation populations. Model performance characteristics improved when Candida colonisation parameters were added post-hoc.
Conclusions
Risk predictive models should factor in both clinical risk factors and Candida colonisation parameters. Integrating these models into therapeutic algorithms first requires external validation in different patient populations and settings.
This is a preview of subscription content, log in via an institution to check access.
References
Kumar A, Roberts D, Wood K, Light B, Parrillo JE, Sharma S, Suppes R, Feinstein D, Zanotti S, Taiberg L, Gurka D, Kumar A, Cheang M (2006) Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 34:1589–1596
Garey KW, Rege M, Pai MP, Mingo DE, Suda KJ, Turpin RS, Bearden DT (2006) Time to initiation of fluconazole therapy impacts mortality in patients with candidemia: a multi-institutional study. Clin Infect Dis 43:25–31
Morrell M, Fraser VJ, Kollef MH (2005) 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 49:3640–3645
Reimer LG, Wilson ML, Weinstein MP (1997) Update on detection of bacteremia and fungemia. Clin Microbiol Rev 10:444–465
Playford EG, Eggimann P, Calandra T (2008) Antifungals in the ICU. Curr Opin Infect Dis 21:610–619
Playford EG, Webster AC, Sorrell TC, Craig JC (2006) Antifungal agents for preventing fungal infections in non-neutropenic critically ill and surgical patients: systematic review and meta-analysis of randomized clinical trials. J Antimicrob Chemother 57:628–638
Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, Kan V, Kauffman CA, Kett D, Larsen RA, Morrison V, Nucci M, Pappas PG, Bradley ME, Major S, Zimmer L, Wallace D, Dismukes WE, Rex JH (2007) Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis 26:271–276
Ostrosky-Zeichner L, Pappas P, Shoham S, Reboli A, Barron M, Sims C, Wood C, Sobel J (2006) Revalidation and improvement of a clinical prediction rule (CPR) for clinical trials on prophylaxis of invasive candidiasis (IC). In: Proceedings and abstract of the 46th interscience conference on antimicrobial agents and chemotherapy. American Society for Microbiology, San Francisco
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758
Paphitou NI, Ostrosky-Zeichner L, Rex J (2005) Rules for identifying patients at increased risk for candidal infections in the surgical intensive care unit: approach to developing practical criteria for systemic use in antifungal prophylaxis trials. Med Mycol 43:235–243
Eggimann P, Garbino J, Pittet D (2003) Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis 3:685–702
Leon C, Ruiz-Santana S, Saavedra P, Galvan B, Blanco A, Castro C, Balasini C, Utande-Vazquez A, Gonzalez de Molina FJ, Blasco-Navalproto MA, Lopez MJ, Charles PE, Martin E, Hernandez-Viera MA, Cava Study Group (2009) 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 37:1624–1633
Leon C, Ruiz-Santana S, Saavedra S, Almirante B, Nolla-Salas J, Alvarez-Lerma F, Garnacho-Montero J, Leon MA (2006) A bedside scoring system (“Candida score”) for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. Crit Care Med 34:730–737
Lipsett PA (2006) Surgical critical care: fungal infections in surgical patients. Crit Care Med 34:S215–S224. PMID 16917426
Leon C, Ruiz-Santana S, Saavedra P, Galvan B, Blanco A, Castro C, Balasini C, Utande-Vazquez A, Gonzalez de Molina F, Blasco-Navalproto M, Lopez M, Charles PE, Martin E, Hernandez-Viera MA, Cava Study Group (2009) 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 37(5):1624–1633
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook DJ, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256
Magill SS, Swoboda SM, Johnson EA, Merz WG, Pelz RK, Lipsett PA, Hendrix CW (2006) The association between anatomic site of Candida colonization, invasive candidiasis, and mortality in critically ill surgical patients. Diagn Microbiol Infect Dis 55:293–301
Acknowledgments
This study was funded in part by a National Health and Medical Research Council Project Grant (512307) and Centre for Clinical Research Excellence Program Grant (264625), and an unrestricted grant from Pfizer Inc. None of the funding institutions were involved in the study design, data collection, analysis, or publication process. Members of the Prospective Surveillance of Invasive Fungal Infections in Australia ICUs Study Group are: Geoffrey Playford, Chris Joyce, Joan Faoagali, Neil Underwood, and Barbara Johnson (Princess Alexandra Hospital, Brisbane); Jeff Lipman, David Paterson, Graeme Nimmo, Cheryl Fourie, Janine Stuart, and Narelle George (Royal Brisbane and Women’s Hospital), Tania Sorrell, Jon Iredell, John Gallagher, Masrura Kabir, Claire Kesby, and Anna Lau (Westmead Hospital); Emma McBryde, Leanne Redl, and Caroline Marshall (Royal Melbourne Hospital); Kyra Chua, Ben Rogers, and Tom Schultz (Victorian Infectious Diseases Reference Laboratory); and Debbie Marriott (St Vincents Hospital, Sydney) and Michael Jones (Macquarie University, Sydney).
Author information
Authors and Affiliations
Corresponding author
Additional information
On behalf of PSIFIC Study Group.
Rights and permissions
About this article
Cite this article
Playford, E.G., Lipman, J., Kabir, M. et al. Assessment of clinical risk predictive rules for invasive candidiasis in a prospective multicentre cohort of ICU patients. Intensive Care Med 35, 2141–2145 (2009). https://doi.org/10.1007/s00134-009-1619-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-009-1619-9