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Evaluation of Candida score in critically ill patients a prospective, multicenter, observational, cohort study.doc

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Evaluation of Candida score in critically ill patients a prospective, multicenter, observational, cohort study

Leroyetal.AnnalsofIntensiveCare2011,1:50 /content/1/1/50 RESEARCH OpenAccess Evaluationof“Candidascore”incriticallyill patients:aprospective,multicenter, observational,cohortstudy GuillaumeLeroy1,FabienLambiotte2,DidierThévenin3,ChristianLemaire4,ErikaParmentier5,PatrickDevos6and OlivierLeroy1* Abstract Introduction:Althoughpromptinitiationofappropriateantifungaltherapyisessentialforthecontrolofinvasive Candidainfectionsandanimprovementofprognosis,earlydiagnosisofinvasivecandidiasisremainsachallenge andcriteriaforstartingempiricalantifungaltherapyinICUpatientsarepoorlydefined.Somescoringsystems,such asthe“Candidascore”couldhelpphysicianstodifferentiatepatientswhocouldbenefitfromearlyantifungal treatmentfromthoseforwhominvasivecandidiasisishighlyimprobable.Thisstudyevaluatedtheperformanceof thisscoreinacohortofcriticallyillpatients. Methods:Aprospective,observational,multicenter,cohortstudywasconductedfromJanuary2010toMarch2011 infiveintensivecareunitsinNord-PasdeCalais,anareafromNorthofFrance.Allpatientsexhibiting,onICU admissionorduringtheirICUstay,ahospital-acquiredseveresepsisorsepticshockcouldbeincludedinthis study.ThedatacollectedincludedpatientcharacteristicsonICUadmissionandattheonsetofseveresepsisor septicshock.The“Candidascore”wascalculatedattheonsetofsepsisorshock.Theincidenceofinvasive candidiasiswasdeterminedanditsrelationshipwiththevalueofthe“Candidascore”wasstudied. Results:Ninety-fourpatientswerestudied.Whenseveresepsisorshockoccurred,44patientshadascore=2,29 patientshadascore=3,17patientshadascore=4,and4patientshadascore=5.Invasivecandidiasiswas observedinfive(5.3%)patients.Onepatienthadcandidemia,threepatientshadperitonitis,andonepatienthad pleuralinfection.Theratesofinvasivecandidiasiswas0%inpatientswithscore=2or3,17.6%inpatientswith score=4,and50%inpatientswithscore=5(p0.0001). Conclusions:Ourresultsconfirmthatthe“Candidascore”isaninterestingtooltodifferentiateamongICUpatients whoexhibithospital-acquiredseveresepsisorsepticshockthosewouldbenefit