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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Candida colonization as a risk marker for invasive candidiasis in mixed medical-surgical intensive care units: Development and evaluation of a simple, standard protocol
Journal of Clinical Microbiology, Volume 53, No. 4, Year 2015
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Description
Colonization with Candida species is an independent risk factor for invasive candidiasis (IC), but the minimum and most practicable parameters for prediction of IC have not been optimized. We evaluated Candida colonization in a prospective cohort of 6,015 nonneutropenic, critically ill patients. Throat, perineum, and urine were sampled 72 h post-intensive care unit (ICU) admission and twice weekly until discharge or death. Specimens were cultured onto chromogenic agar, and a subset underwent molecular characterization. Sixty-three (86%) patients who developed IC were colonized prior to infection; 61 (97%) tested positive within the first two time points. The median time from colonization to IC was 7 days (range, 0 to 35). Colonization at any site was predictive of IC, with the risk of infection highest for urine colonization (relative risk [RR] = 2.25) but with the sensitivity highest (98%) for throat and/or perineum colonization. Colonization of ≥2 sites and heavy colonization of ≥1 site were significant independent risk factors for IC (RR = 2.25 and RR = 3.7, respectively), increasing specificity to 71% to 74% but decreasing sensitivity to 48% to 58%. Molecular testing would have prompted a resistance-driven decision to switch from fluconazole treatment in only 11% of patients infected with C. glabrata, based upon species-level identification alone. Positive predictive values (PPVs) were low (2% to 4%) and negative predictive values (NPVs) high (99% to 100%) regardless of which parameters were applied. In the Australian ICU setting, culture of throat and perineum within the first two time points after ICU admission captures 84% (61/73 patients) of subsequent IC cases. These optimized parameters, in combination with clinical risk factors, should strengthen development of a setting-specific risk-predictive model for IC. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
Authors & Co-Authors
Chen, Sharon Chih Ann
Australia, Sydney
Westmead Hospital
Jones, Michael P.
Australia, Macquarie Park
The Faculty of Medicine, Health and Human Sciences
Lipman, Jeffrey
Australia, Brisbane
Royal Brisbane and Women's Hospital
McBryde, Emma Sue
Australia, Melbourne
Royal Melbourne Hospital
Gottlieb, Thomas
Australia, Sydney
Concord Repatriation General Hospital
Seppelt, Ian
Australia, Penrith
Nepean Hospital
Iredell, Jonathan R.
Australia, Sydney
Westmead Hospital
Australia, Sydney
The University of Sydney
Sorrell, Tania C.
Australia, Sydney
Westmead Hospital
Australia, Sydney
The University of Sydney
Statistics
Citations: 43
Authors: 8
Affiliations: 9
Identifiers
Doi:
10.1128/JCM.03239-14
ISSN:
00951137
Research Areas
Health System And Policy
Study Design
Cohort Study