Published in:
01-04-2007 | Concise Article
Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting
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
Published in:
European Journal of Clinical Microbiology & Infectious Diseases
|
Issue 4/2007
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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.