TY - JOUR
T1 - Problematic dichotomization of risk for intensive care unit (ICU)-acquired invasive candidiasis
T2 - Results using a risk-predictive model to categorize 3 levels of risk from a multicenter prospective cohort of Australian ICU patients
AU - Playford, E. Geoffrey
AU - Lipman, Jeffrey
AU - Jones, Michael
AU - Lau, Anna F.
AU - Kabir, Masrura
AU - Chen, Sharon C.-A.
AU - Marriott, Deborah J.
AU - Seppelt, Ian
AU - Gottlieb, Thomas
AU - Cheung, Winston
AU - Iredell, Jonathan R.
AU - McBryde, Emma S.
AU - Sorrell, Tania C.
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background: Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. Methods: A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived. Results: Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%). Conclusions: Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.
AB - Background: Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. Methods: A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived. Results: Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%). Conclusions: Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.
KW - Candidemia
KW - Critical care
KW - Invasive candidiasis
KW - Prophylaxis
KW - Risk prediction
UR - http://www.scopus.com/inward/record.url?scp=85014967893&partnerID=8YFLogxK
U2 - 10.1093/cid/ciw610
DO - 10.1093/cid/ciw610
M3 - Article
C2 - 27601224
SN - 1058-4838
VL - 63
SP - 1463
EP - 1469
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 11
ER -