Candida Score as a Predictor of Worse Outcomes and Mortality in Severely Injured Trauma Patients with Positive Candida Cultures

Abstract

Invasive candidiasis is associated with worse outcomes and increased mortality in critically ill patients. The Candida score (CS) provides a clinical tool for identifying patients at risk for invasive candidiasis. Outcomes of severely injured trauma patients with positive Candida cultures stratified by their CS have not been well described. In this retrospective observational study, all severely injured trauma patients (Injury Severity Score ≥16) admitted to the Los Angeles County and University of Southern California Medical Center from April 2008 to April 2014 with positive Candida cultures were included. Outcomes of patients with a low risk for invasive candidiasis (CS < 3) were compared with those with a high risk (CS ≥ 3). A CS ≥ 3 was significantly associated with higher mortality (35.9% vs 5.0%, P = 0.001), longer length of stay (LOS) (median 49.0 vs 28.0, P = 0.002), longer intensive care unit LOS (35.0 vs 20.0, P < 0.001), requirement for renal replacement therapy (38.5% vs 4.9%, P < 0.001), and increased ventilator days (22.0 vs 12.0, P < 0.001). Multi-variable regression analysis revealed a CS ≥ 3 as a significant predictor for increased mortality [OR 6.983], longer LOS [regression coefficient (RC) 1.572] and intensive care unit LOS (RC 1.698), more frequent need for renal replacement therapy (OR 13.268), and increased ventilator days (RC 1.836). In conclusion, a CS ≥ 3 is significantly associated with increased mortality and worse outcomes in severely injured trauma patients with positive Candida cultures. The CS thus may serve as a clinical tool to predict outcomes in this patient population.

Epidemiology, clinical characteristics, and outcome of candidemia in critically ill patients in Germany: a single-center retrospective 10-year analysis

“…Next to the SOFA score as an indicator of morbidity in critical care patients and the presence of septic shock, we found an association between the Candida score and reduced survival at 28 and 180 days [ 28 ]. All factors that were identified as predictors of poor outcome in our study population have been linked with increased mortality in ICU patients before [ 29 – 31 ]. Thus, our results confirm the importance of disease severity and multiorgan dysfunction for the prognosis after Candida BSI.…”

A Rapid Procedure for Identification and Antifungal Susceptibility Testing of Yeasts From Positive Blood Cultures

“…Bloodstream infections (BSIs) are among the main causes of morbidity and mortality in hospitalized patients ( Buehler et al, 2016 ). In this context, invasive Candida infections are associated with frequently unfavorable outcomes ( Haltmeier et al, 2015 ) and mortality rates higher than 60% in critically ill patients ( Kett et al, 2011 ; Guo et al, 2013 ; Barchiesi et al, 2014 , 2017 ), especially when they are not timely and appropriately treated ( Garey et al, 2006 ). In general, yeast identification is clinically relevant since different Candida species may differ in virulence and drug resistance.…”