Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting
European Journal of Clinical Microbiology and Infectious Diseases
The study presented here was performed in order to create a rule that identifies subjects at high risk for invasive candidiasis in the intensive care setting. Retrospective review and statistical modelling were carried out on 2,890 patients who stayed at least 4 days in nine hospitals in the USA and Brazil; the overall incidence of invasive candidiasis in this group was 3% (88 cases). The best performing rule was as follows: Any systemic antibiotic (days 1-3) OR presence of a central venous catheter (days 1-3) AND at least TWO of the following-total parenteral nutrition (days 1-3), any dialysis (days 1-3), any major surgery (days -7-0), pancreatitis (days -7-0), any use of steroids (days -7-3), or use of other immunosuppressive agents (days -7-0). The rate of invasive candidiasis among patients meeting the rule was 9.9%, capturing 34% of cases in the units, with the following performance: relative risk 4.36, sensitivity 0.34, specificity 0.90, positive predictive value 0.01, and negative predictive value 0.97. The rule may identify patients at high risk of invasive candidiasis. © 2007 Springer-Verlag.
Ostrosky-Zeichner, L., Sable, C., Sobel, J., Alexander, B., Donowitz, G., Kan, V., Kauffman, C., Kett, D., Larsen, R., Morrison, V., Nucci, M., Pappas, P., Bradley, M., Major, S., Zimmer, L., Wallace, D., Dismukes, W., & Rex, J. (2007). Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. European Journal of Clinical Microbiology and Infectious Diseases, 26 (4). http://dx.doi.org/10.1007/s10096-007-0270-z