Rule of Paphitou et al for Risk-Stratified Prophylaxis Against Candida Infections of a Patient in the Surgical Intensive Care Unit (ICU)

Patient selection: >= 4 days in a surgical ICU

Risk factors for invasive candidiasis:

(1) diabetes mellitus

(2) new onset of hemodialysis

(3) use of total parenteral nutrition (TPN)

(4) recent history of broad-spectrum antibiotic therapy (during week prior to ICU admission or while in the ICU)

A patient with any combination of these risk factors had a 17% rate of invasive candidiasis vs 5% for someone with none of them. It identified almost 80% of patients who developed invasive candidiasis.

Limitations:

• The rules need to be validated in non-surgical ICUs.

• A method of early detection for the 20% of patients not identified by the rule needs to be developed.

• The impact of tight glucose control in the ICU may need to be considered.