What is the most useful prognostic factor for candidaemia in ICU patients?
The cumulative number of risk factors for invasive candidiasis is the most useful prognostic indicator for candidaemia in intensive care unit (ICU) patients, according to a recent study.
“This variable ought to be utilized as a means of validating the timing of initiating antifungal therapy to decrease in-hospital mortality,” researchers said.
A retrospective cohort study of patients with candidaemia (n=25; median age 69 years; 56.0 percent male) in the emergency ICU at Fukuoka University Hospital in Japan from 2010 to March 2015 was conducted to establish the best prognostic factor for such patients. The authors collected clinical and demographic data from the participants’ medical records and laboratory databases.
Of the patients included in the study, 18 died during hospitalization, resulting in an in-hospital mortality rate of 72.0 percent. [Singapore Med J 2017;58:196-200]
Majority of the patients used broad-spectrum antimicrobial agents (84.0 percent), mechanical ventilation (72.0 percent), gastric acid suppression (100.0 percent) and had an ICU stay of >3 days (76.0 percent). In addition, about half of them (44.0 percent) received total parenteral nutrition.
The median length of ICU stay prior to the onset of candidaemia was 13 (range 1 to 73) days. More than half of the patients (56.0 percent) were diagnosed with sepsis as the primary diagnosis on admission, and its most common causes were pneumonia (21.4 percent) or skin and soft-tissue infections (21.4 percent).
The variables of Sequential Organ Failure Assessment (SOFA) score, which estimates organ dysfunction related to various disease statuses, and cumulative number of risk factors for invasive candidiasis demonstrated significant differences between patients in the survivor and nonsurvivor groups (p<0.05) when the factors linked to in-hospital mortality were compared.
The area under the receiver operating characteristics curves for the SOFA score was 0.873 (95 percent CI, 0.72 to 1.00) and that for the cumulative number of risk factors for invasive candidiasis was 0.937 (0.84 to 1.00).
“Epidemiological data on invasive candidiasis from the United States’ National Center for Health Statistics showed that the risk factors associated with invasive candidiasis were well established and had not changed substantially over the last two decades,” researchers said. [Clin Microbiol Rev 2007;20:133-63]
“As these risk factors are also not expected to change greatly in the future, the cumulative number of risk factors for invasive candidiasis is a valuable measure for predicting the outcome of candidaemia,” they added.
The study was limited by its small sample size and its single-centre design. In addition, researchers failed to identify the unknown risk factors for invasive candidiasis (eg, new biomarkers), possible contamination of blood cultures, the adequate type and dosage of antifungal agents for treatment and the weighting of each risk factor for invasive candidiasis.
Invasive candidiasis is known to include candidaemia and deep-seated candidiasis, which are infections of tissue sites beneath the mucosal surface, and is one of the most familiar nosocomial infections. Patients admitted to an ICU are at an elevated risk of developing invasive candidiasis, according to researchers. [Clin Infect Dis 2013;56:1284-92; Clin Infect Dis 2004;39:309-17; Clin Microbiol Rev 2007;20:133-63]