Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting |
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| Authors: | L Ostrosky-Zeichner C Sable J Sobel B D Alexander G Donowitz V Kan C A Kauffman D Kett R A Larsen V Morrison M Nucci P G Pappas M E Bradley S Major L Zimmer D Wallace W E Dismukes J H Rex |
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| Institution: | (1) University of Texas Health Science Center at Houston, 6431 Fannin, MSB 2.112, Houston, TX 77030, USA;(2) Merck Research Laboratories, 10 Sentry Parkway, BL3-4, Blue Bell, PA 19422, USA;(3) Wayne State University, Harper Professional Building, Suite 2140, 3990 John Road, 4 Brush Center, Detroit, MI 48201, USA;(4) Duke University Medical Center, P.O. Box 3038, Research Dr., 116G Carl Building, Durham, NC 27710, USA;(5) University of Virginia Health System, P.O. Box 801343, MR-4 Building, Room 2118A, 300 Pk. Pl, Charlottesville, VA 22908, USA;(6) VA Medical Center, 50 Irving Street N.W, Washington, DC 20422, USA;(7) University of Michigan Medical Center, 2215 Fuller Road, Room 839-A, Ann Arbor, MI 48105, USA;(8) Jackson Memorial Hospital, 1611 NW 12th Avenue, Miami, FL 33136, USA;(9) Univeristy of Southern California, 2020 Zonal Avenue, Room 632, Los Angeles, CA 90033, USA;(10) VA Medical Center, One Veterans Drive, 111E, Minneapolis, MN 55417-2300, USA;(11) Hospital Universitário Clementino Fraga Filho Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil;(12) University of Alabama at Birmingham, 1900 University Boulevard, 222THT, Birmingham, AL 35294, USA;(13) University of Alabama at Birmingham, 1922 7th Avenue South, Kracke Building 731, Birmingham, AL 35249, USA;(14) Rho, 6330 Quadrangle Drive, Suite 500, Chapel Hill, NC 27517, USA;(15) AstraZeneca, Alderley House, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK |
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| Abstract: | The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis
in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed
at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3%
(88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1–3) OR presence of a central venous catheter
(days 1–3) AND at least TWO of the following—total parenteral nutrition (days 1–3), any dialysis (days 1–3), any major surgery
(days −7–0), pancreatitis (days −7–0), any use of steroids (days −7–3), or use of other immunosuppressive agents (days −7–0).
The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following
performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive
value 0.97. The rule may identify patients at high risk of invasive candidiasis.
Results of this project were partially presented at Focus on Fungal Infections 14, New Orleans, LA, USA, 2004. Abstract no.
51. |
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