| A bedside scoring system ("Candida score") for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization. | |
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MedLine Citation:
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PMID: 16505659 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Cristóbal León; Sergio Ruiz-Santana; Pedro Saavedra; Benito Almirante; Juan Nolla-Salas; Francisco Alvarez-Lerma; José Garnacho-Montero; María Angeles León; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Critical care medicine Volume: 34 ISSN: 0090-3493 ISO Abbreviation: Crit. Care Med. Publication Date: 2006 Mar |
Date Detail:
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Created Date: 2006-02-28 Completed Date: 2006-04-10 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 730-7 Citation Subset: AIM; IM |
Affiliation:
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Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain. cleong@telefonica.net |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Algorithms* Antifungal Agents / therapeutic use* Candidiasis / diagnosis, drug therapy* Critical Illness Female Fungemia / prevention & control* Humans Logistic Models Male Middle Aged Models, Theoretical Patient Selection* Prospective Studies ROC Curve Reproducibility of Results Risk Assessment Risk Factors Sensitivity and Specificity Spain / epidemiology |
| Chemical | |
Reg. No./Substance:
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0/Antifungal Agents |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2006 Mar;34(3):913-4
[PMID:
16505683
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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