Factors identifying a patient at risk for disseminated colonization or infection with Candida:
(1) presence of early risk factors at the time of admission to the surgical ICU
(2) high incidence of risk factors
(3) rapid increase in risk factors over the stay in the ICU
Early risk factors (present on day 1 of admission to ICU):
(1) total parenteral nutrition
(2) central catheter, especially if in place > 72 hours
(3) previous SICU admission (s)
(4) previous surgical procedure(s)
(5) diarrhea
Additional risk factors for Candida disseminated colonization or infection (from Tables 2 and 3, page 1404-1405):
(5) lack of enteral or intravenous feeding
(6) mechanical ventilation
(7) white blood cell count > 10,000 per µL
(8) broad spectrum antibiotics
(9) fever (> 38.5°C) or hypothermia (< 36°C) while on antibiotics
(10) solid tumor
(11) hemodialysis
(12) total parenteral nutrition
(13) central catheter placement
(14) central catheter > 72 hours
Other risk factors for Candida infections not found to distinguish patients who were not colonized or who had local colonization from those with disseminated colonization or infection:
(1) organ transplant
(2) corticosteroid at nonphysiologic doses for more than 4 days
(3) severe burns
(4) diabetes mellitus
(5) urinary bladder catheter
(6) serum creatinine > 2 mg/dL
(7) presence of a peripheral catheter
(8) GI surgery
(9) lymphocytopenia (absolute lymphocyte count < 1,000 per µL)
