Score de candidemia

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

Objective: To obtain a score for deciding early antifungal
treatment when candidal infection is suspected in nonneutropenic
critically ill patients.
Design: 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.
Setting: Seventy-three medical-surgical ICUs of 70 teaching
hospitals in Spain.
Patients: 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.
Interventions: 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.
Measurements and main results: 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).
Conclusions: 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. (Crit Care Med
2006; 34:730–737)
KEY WORDS: Candida colonization; intensive care unit; critically
ill patients; Candida score; preemptive antifungal therapy; invasive
candidiasis Ver artículo completo
Gracias a Romina Hansen por acercarnos el artículo