Candida scores

Ref ID: 17726

Author:

S. Ruiz-Santana*,

Author address:

C. León on behalf of the CAVA II Study
Group

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Colonization and Candidemia (C)/Invasive Candidiasis (IC) are difficult
to distinguish in ICU patients. Predictive models in adult nonneutropenic
critically ill patients allow stratification and selection of
high-risk patients for C/IC who may benefit from early antifungal
therapy. Our group has developed and validated the ’’Candida score’’, a
predictive model of IC, based on a scoring system for certain variables,
which assigns a value of 1 point for surgery, multifocal colonization
and parenteral nutrition, and a value of two points severe sepsis. A
cutoff of “¡3 is highly reliable to identify patients at high risk of C/IC.
Moreover, abdominal surgery increases significantly the risk of C/IC.
Based on these results, early antifungal treatment can be specifically
directed to patients with multifocal Candida colonization and associated
Candida score “¡3 and, in particular, to those with abdominal surgery.
This scoring system is simple and may be of help to clinicians to
differentiate between Candida spp. colonization and occult invasive
fungal infection when early antifungal treatment is considered.
Serological tests have been recently added to the diagnostic armamentarium
of C/IC, including detection of Candida albicans germ tube
antibodies (CAGTA) and (1,3)-Beta-D-Glucan (BDG). A recent metaanalysis
concluded that BDG has good diagnostic accuracy for
distinguishing patients with and without invasive fungal infection.
Proper use of this test requires good knowledge of its characteristics,
particularly the fungal pathogens that remain undetected and the factors
associated with a false-positive result. PCR-based methods to detect
Candida spp. directly in blood samples may play an important role in
improving the outcome of patients with IC through an earlier and more
sensitive diagnosis. A recently published meta-analysis has demonstrated
the usefulness of this method, which may accompany blood
cultures, although serial sampling may be considered for patients at
high risk for IC. This systematic review demonstrated that direct PCR in
blood samples may have higher sensitivity for the diagnosis of IC than
conventional blood cultures, with a specificity of 90%. Therefore,
stratification of patients at high risk for IC with the use of a predictive
model of IC together with measurements of biomarkers (BDG and
CAGTA) and the possibility of having available diagnostic tests based
on real time PCR may change the outcome of patients with IC.

Abstract Number: NULL

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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