Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting

L. Ostrosky-Zeichner, C. Sable, J. Sobel, B. D. Alexander, G. Donowitz, V. Kan, C. A. Kauffman, D. Kett, R. A. Larsen, Vicki A Morrison, M. Nucci, P. G. Pappas, M. E. Bradley, S. Major, L. Zimmer, D. Wallace, W. E. Dismukes, J. H. Rex

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243 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)271-276
Number of pages6
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume26
Issue number4
DOIs
StatePublished - Apr 2007

Bibliographical note

Funding Information:
Acknowledgments This project was supported by a grant from Merck and Co, Inc. and funded in part by the National Institute of Allergy and Infectious Diseases, National Institutes of Health under Contract Numbers N01-AI-15440 and N01-AI-15441. V.K. wishes to acknowledge the participation of the VA Medical Center, Washington, DC in this study. The authors wish to thank T. Nolen for her independent validation of the statistics and data-set and P. Stephenson for her independent statistical review of this manuscript. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government.

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