Paphitou et al developed a prediction rule to help identify a patient in the Surgical Intensive Care Unit (ICU) who may be at increased risk for invasive candidiasis. Such a patient may benefit from more aggressive monitoring and prophylactic antifungal therapy. The authors are from the University of Texas at Houston.

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.



• 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.

To read more or access our algorithms and calculators, please log in or register.