A bedside scoring system ("Candida score'') for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization
A bedside scoring system ("Candida score'') for early antifungal treatment in nonneutropenic critically ill patients with Candida colonization
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DOI：
10.1097/01.ccm.0000202208.37364.7d
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发表时间：
2006-03-01
影响因子：
8.8
通讯作者：
León, MA
中科院分区：
文献类型：
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作者：
León, C;Ruiz-Santana, S;León, MA
目的：当怀疑非中性粒细胞减少的重症患者出现念珠菌感染时，获得评分以决定早期抗真菌治疗。设计：分析从EPCAN项目数据库收集的数据，EPCAN项目是一项正在进行的前瞻性、队列、观察性、多中心监测研究重症监护室（ICU）患者的真菌感染和定植。设置：西班牙70家教学医院的73个内科-外科ICU。患者：研究对象为1998年5月至1999年1月期间入住ICU至少7天的1,699例年龄在18岁及以上的患者。每周获得尿液、气管和胃样本的监测培养物。患者分组如下：既没有定植也没有感染（n = 719），单灶性或多灶性念珠菌定植（n = 883），并证实念珠菌感染（n = 97）。估计与定植相关的每个风险因素与已证实的念珠菌感染的比值比（OR）。进行逻辑回归模型以校正可能的混杂因素。根据logit方法获得“念珠菌评分”。以受试者工作特征曲线下面积（ROC曲线下面积）作为判别能力的评价指标。（OR = 2.71，95%置信区间[CI]，1.45-5.06）;多灶性定植（OR = 3.04，95% CI，1.45-6.39）、全肠外营养（OR = 2.48，95% CI，1.16-5.31）和严重脓毒症（OR = 7.68，95% CI，4.14-14.22）是确诊念珠菌感染的预测因子。临界值为2.5的“念珠菌评分”（敏感性81%，特异性74%）如下：肠外营养，+0.908;手术，+0.997;多灶性定植，+1.112;和严重败血症，+2.038。中心静脉导管不是已证实的念珠菌感染的显著危险因素（p = 0.292）。在一个前瞻性评估念珠菌定植的非血小板减少性重症患者的大型队列中，“念珠菌评分”>2.5准确选择了将从早期抗真菌治疗中获益的患者。
Objective: To obtain a score for deciding early antifungal treatment when candidal infection is suspected in nonneutropenic critically ill patients.Design: Analysis of data collected from the database of the EPCAN project, an ongoing prospective, cohort, observational, multicenter surveillance study Of fungal infection and colonization in intensive care unit (ICU) patients.Setting: Seventy-three medical-surgical ICUs of 70 teaching hospitals in Spain.Patients: A total of 1,699 ICU patients aged 18 yrs and older admitted for at least 7 days between May 1998 and January 1999 were studied.Interventions. Surveillance cultures of urine, tracheal, and gastric samples were obtained weekly. Patients were grouped as follows: neither colonized nor infected (n = 719), unifocal or multifocal Candida colonization (n = 883), and proven candidal infection (n = 97). The odds ratio (OR) for each risk factor associated with colonization vs. proven candidal infection was estimated. A logistic regression model was performed to adjust for possible confounders. The "Candida score" was obtained according to the logit method. The discriminatory power was evaluated by the area under the receiver operating characteristics curve.Measurements and main results: In the logit model, surgery (OR = 2.71, 95% confidence interval [CI], 1.45-5.06); multifocal colonization (OR = 3.04, 95% Cl, 1.45-6.39); total parenteral nutrition (OR = 2.48, 95% Cl, 1.16-5.31); and severe sepsis (OR = 7.68, 95% Cl, 4.14-14.22) were predictors of proven candidal infection. The "Candida score" for a cut-off value of 2.5 (sensitivity 81%, specificity 74%) was as follows: parenteral nutrition, +0.908; surgery, +0.997; multifocal colonization, +1.112; and severe sepsis, +2.038. Central venous catheters were not a significant risk factor for proven candidal infection (p =.292).Conclusions. In a large cohort of nonneutropenic critically ill patients in whom Candida colonization was prospectively assessed, a "Candida score" >2.5 accurately selected patients who would benefit from early antifungal treatment.