Ostrosky-Zeichner et al developed a clinical rule to identify a patient in the intensive care unit (ICU) at increased risk for invasive candidiasis. This can help to select patients for clinical trials of antifungal prophylaxis. The authors are from the University of Texas at Houston and multiple other institutions in the United States.
Patient selection: in ICU >= 4 days
Exclusions: neutropenia, transplant (solid or hematologic), burn, HIV-1
Rule to identify a patient at increased risk - all of the following:
(1) mechanical ventilation for >= 48 hours
(2) antibacterial antibiotic therapy on ICU days 1, 2 and 3
(3) central venous catheter on ICU days 1, 2 or 3
(4) one or more of the following:
(4a) any recent surgery
(4b) immunosuppressive therapy in week prior to admission to ICU
(4c) pancreatitits
(4d) total parenteral nutrition
(4e) any dialysis
(4f) corticosteroid therapy in week prior to admission to ICU
where:
• There are 2 ways to count days in the ICU. Some count the first 23.9 hours in the ICU as being on day 0 while others call it day 1. The former appears to be the current usage.
The goal of the rule was to have an incidence of invasive candidiasis of about 10%. The current rule applied to 18% of ICU patients and had an incidence rate of 10% with relative risk risk of 4 and accuracy of 81%. The sensitivity was 50%, specificity 83%, positive predictive value 10% and negative predictive value 97%.
