Diagnostic Value of Candida Colonization Index in The Early Diagnosis of Invasive Candidal Infection
Abstract
Objective: To investigate the diagnostic value of Candida colonization index (CCI) in the early diagnosis of invasive candidal infection in medical mix (medical and surgical intensive care units (ICU). Methods: Mouth, axillae, nasogastric catheter, rectum, and urine culture samples taken from the patients admitted to the reanimation and neurological ICU for 19 months were retrospectively evaluated and CCI were calculated. Results: CCI reached ≥0,5 in the cultures of 29 patients. 29 patients developed candidal infection; 27 (27/29) of them had CCI ≥0,5. 18 patients developed urinary infections, 10 patients developed candidemia, and 1 patient developed wound infection. CCI ≥0,5 was found as the only independent predictor for invasive candidal infection (p<0,001, OR: 701,553, %95 CI; 28,310-17385,22). The positive predictive value, sensitivity, and specifity of CCI for the candidal infection were found to be 93.1% and 96.2%, respectively. Conclusions: We concluded that monitoring for CCI in patients with unknown fever, severe sepsis or septic shock in the medical ICU offers an early diagnosis and intervention to prevent invasive candidal infection. Independently from the other risk factors, CCI may be considered as an effective test for early diagnosis of invasive candidal infection in medical and surgical ICU patients.References
Kett DH, Azoulay E, Echeverria PM, Vincent JL; Extended Prevelance of Infection in ICU Study (EPIC II) Group. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study. Crit Care Med 2011;39:665-70.
Pappas PG. Invasive candidiasis. Infect Dis Clin North Am. 2006;20: 485–506.
Delaloye J, Calandra T. Invasive candidiasis as a cause of sepsis in the critically ill patient. Virulence. 2014; 5:161-9.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999; 27: 887-92.
Vardakas KZ, samonis G, Michalopoulos A, Soteriades ES, Falagas ME. Antifungal prophylaxis with azoles in high-risk, surgical intensive care unit patients: a meta- analysis of randomized, placebo-controlled trials. Crit Care Med 2006;34: 1216-24.
Vardaks KZ, Michalopoulos A, Kiriakidou KG, Siampli EP, Samonis G, Falagas ME. Candidemia: incidence, risk factors, characteristics and outcomes in immunocompetent critically ill patients. Clin Microbiol Infect 2009;15:289-92
Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994;220:751-8.
Eggimann P, Francioli P, Bille J et al. Fluconazole prophylaxis prevents intra-abdominal candidiasis in high-risk surgical patients. Crit Care Med 1999;27:1066-72.
Piarroux R, Grenouillet F, Balvay P, Tran V, Blasco G, Millon L, et al. Assessment of preemptive treatment to prevent severe candidiasis in critically-ill surgical patients. Crit Care Med 2004;32:2443-9.
Garbino J, Kolarova L, Rohner P, Lew D, Pincha P, Pittet D. Secular trends of candidemia over 12 years in adult patients at tertiary care hospital. Medicine (Baltimore) 2002;81:425-33.
León C, Ostrosky-Zeichner L, Schuster M. What’s new in the clinical and diagnostic management of invasive candidiasis in critically ill patients. Intensive Care Med. 2014;40:808-19.
Charles PE, Dalle F, Aube H, Doise JM, Quenot JP, Aho LS, et al. Candida spp. colonization significance in critically ill medical patients: a prospective study. Int Care Med 2005;31:393-400.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions of nosocomial infections, 1998. Am J Infect Control 1998;16:128-40.
Esen Ş. Yoğun bakımda fungal enfeksiyonlar. Arman D, Odabaşı Z (editörler). Fungal İnfeksiyonlar ve Tedavisi Ankara: Bilimsel Tıp Yayınevi 2009;125-35.
Dizbay M. Kolonizasyon indeksi ve klinik anlamı. Arman D (editör). Yoğun bakım ünitesinde Fungal Enfeksiyonlar Ankara. Bilimsel Tıp Yayınevi 2008;27-31.
Blot S, Dimopoulos G, Rello J, Vogelaers D:Is Candida really a threat in the ICU? Curr Opin Crit Care 2008, 14 :600-604.
Pfaller MA, Diekema DJ. Epidemiology of invasive candidiasis: a persistent public health problem. Clin Microbiol Rev. 2007;20:133-63.
Leon C, Ruiz Santana S, Saavedra P, Galvan B, Blanca A, Castro C, et al. Usefulness of the 'Candida score' for discriminating between candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med 2009;37:1624-33.
Vardakas KZ, Michalopoulos A, Kriakidou KG, Siampli EP, Samonis G, Falagas ME. Candidemia: incidence, risk factors, characteristics and outcomes in immunocompetent critically ill patients. Eur J Clin Microbiol Infect Dis 2009;15:286-95.
Agvald-Öhman C, Klıngspor L, Hjelmqvıst, Edlund C. Invasive candidiasis in long term patients at a multidisciplinary intensive care unit: Candida colonization index, risk factors, treatment and outcome. Scand J Infect Dis 2008;40;145-53.
Solomkin JS. Timing of treatment for nonneutropenic patients colonized with Candida. Am J Surg 1996;172(6A):44S-48S.
Charles PE, Doise JM, Quenot JP, Aube H, Dalle F, Chavanet P, et al. Candidemia in critically ill patients: difference of outcome between medical and surgical patients. Int Care Med 2003;29:2162-69.
Leon C, Ruiz-Santana S, Saavedra P, Galvan B, Blanco A, Castro C, et al. Usefulness of the ‘‘Candida score’’ for discriminating between Candida colonization and invasive candidiasis in non-neutropenic critically ill patients: a prospective multicenter study. Crit Care Med 2009; 37: 1624-33.
Lahmer T, Messer M, Mayr U, Saugel B, Noe S, Schultheiss C, et al. Fungal "colonization" is associated with increased mortality in medical intensive care unit patients with liver cirrhosis. Mycopathologia. 2015;179:63-71.
Eggimann P, Pittet D. Candida colonization index and subsequent infection in critically ill surgical patients: 20 years later.Intensive Care Med 2014;40:1429–48
Massou S, Ahid S, Azendour H, Bensghir M, Mounir K, Iken M, et al. Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index. Pathol Biol (Paris). 2013;61:108-12.
Charles PE, Dalle F, Aube H, Doise JM, Quenot JP, Aho LS, Chavanet P, Blettery B. Candida spp. colonization significance in critically ill medical patients: a prospective study. Intensive Care Med. 2005;31:393-400.
