Usefulness of the “Candida score” for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: A prospective multicenter study

Abstract

In this cohort of colonized patients staying >7 days, with a CS <3 and not receiving antifungal treatment, the rate of IC was <5%. Therefore, IC is highly improbable if a Candida-colonized non-neutropenic critically ill patient has a CS <3.

Value of β-d-glucan and Candida albicans germ tube antibody for discriminating between Candida colonization and invasive candidiasis in patients with severe abdominal conditions

“…In agreement with previous studies, the Candida score was significantly higher in patients with IC than in the remaining groups, but the usefulness of this prediction rule is limited in patients undergoing abdominal surgery because in these circumstances the score is consistently higher than the discriminating cutoff point of at least 3. The CART analysis showed a very high negative predictive value, which is in agreement with data obtained by Ostrosky-Zeichner et al [3] with their prediction rule as well as with the CS in our two previous studies [2,4]. However, the CART positive predictive value was 42.4 %, which is clearly higher than 9 % obtained by the prediction rule of Ostrosky-Zeichner et al [3] and 13.8 % with CS in our previous study [4].…”

“…The CART analysis showed a very high negative predictive value, which is in agreement with data obtained by Ostrosky-Zeichner et al [3] with their prediction rule as well as with the CS in our two previous studies [2,4]. However, the CART positive predictive value was 42.4 %, which is clearly higher than 9 % obtained by the prediction rule of Ostrosky-Zeichner et al [3] and 13.8 % with CS in our previous study [4].…”

“…The different Candida isolates were identified at species level. As soon as the results of surveillance cultures were available and at the time of starting antifungal treatment in patients with IC, the Candida score (CS) was calculated [4], with a cutoff point of at least 3 for discriminating between Candida spp. colonization and IC.…”

“…In a previous study [4], BDG was assessed in 65 of 217 non-neutropenic critically ill patients who underwent abdominal operations, yielding 11 patients classified into the neither colonized nor infected group, 45 into the Candida spp. colonization group, and 9 into the IC group.…”

“…Clinical prediction rules are relevant elements enabling proper diagnosis but some of them are not easy to fulfill, have not been previously validated, or may be eventually unhelpful in patients having abdominal surgery (e.g., the Candida score) [2][3][4][5]. Specific antigen components of the fungal cell wall have been exploited for the development of diagnostic assays that can detect the presence of these components in the serum.…”