caa a22 4500 606239650 CHVBK 20210128101304.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s00508-014-0644-z doi (NATIONALLICENCE)springer-10.1007/s00508-014-0644-z Invasive Candida infections in patients of a medical intensive care unit [Elektronische Daten] Attempt of improving diagnosis by quantifying the colonization [Sebastian Kautzky, Thomas Staudinger, Elisabeth Presterl] Invasive Candida- Infektionen bei Intensivpatienten einer internistischen Intensivstation Versuch einer besseren Diagnostik durch Quantifizierung der Kolonisation Summary: Background: During the past decades, a steady increase in the incidence of invasive Candida infections in patients requiring intensive care has been reported. Nevertheless, the diagnosis of invasive Candida infections in the intensive care unit setting remains still difficult and is often made late in the course of disease. Additionally, prognosis worsens rapidly with delayed initiation of antifungal therapy. Clinical scoring systems such as the Candida colonization index or the four risk factor-based Candida score could be very useful tools to select patients at high risk of developing invasive Candida infections, who would benefit from the administration of systemic antifungal therapy. Objectives: The main objective was to determine the incidence of invasive Candida infection among patients of a medical intensive care unit and to investigate its association with the Candida colonization index and the Candida score. Material and methods: A prospective, observational, single-center study was performed from December 2010 to December 2011. All patients over the age of 18 years who were admitted for at least 7 days in a medical intensive care unit were included. Demographic characteristics, underlying diseases, reasons for intensive care unit admission and presence and duration of risk factors for Candida species colonization and infection were collected for each patient. The Candida colonization index and the Candida score were calculated weekly until discharge or death. Results: A total of 65 patients were included. Proven invasive Candida infections were diagnosed in five patients (7.7%), i.e. two developed candidemia, two peritonitis, and one pneumonia. All of these patients were characterized by a Candida colonization index ≥0.5 (incidence rate: 16.7% [5/30]) and a Candida score ≥2.5 (incidence rate: 29.4% [5/17]). Mechanical ventilation (p=0.013) and both Candida scoring systems (p=0.013 versus p<0.001) were statistically and significantly associated with invasive Candida infections. The mortality rate was high (80%). Interestingly, treatment with antifungal drugs was not statistically and significantly associated with invasive candidiasis (p=0.077) and patients outcome (p=0.057). Conclusion: Both the Candida colonization index and the Candida score with cut-off values ≥0.5 and ≥2.5 are very useful tools to select patients at high risk of developing invasive Candida infections in the medical intensive care unit setting, who would benefit from early antifungal treatment. Springer-Verlag Wien, 2014 Invasive candidiasis nationallicence Invasive Candida infection nationallicence Candida colonization index nationallicence Candida score nationallicence Intensive care unit nationallicence Critically ill patients nationallicence Systemic antifungal therapy nationallicence Invasive Candida Infektionen/Candidiasis nationallicence Candida Colonization Index/CCI nationallicence Candida Score/CS nationallicence Intensivstation/Intensivpatienten nationallicence Systemische antimykotische Therapie nationallicence Kautzky Sebastian LK Waidhofen/Ybbs, Waidhofen/Ybbs, Austria aut Staudinger Thomas Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria aut Presterl Elisabeth Clinical Institute of Hospital Hygiene, Medical University of Vienna, Vienna, Austria aut Wiener klinische Wochenschrift Springer Vienna 127/3-4(2015-02-01), 132-142 0043-5325 127:3-4<132 2015 127 508 https://doi.org/10.1007/s00508-014-0644-z text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00508-014-0644-z text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kautzky Sebastian LK Waidhofen/Ybbs, Waidhofen/Ybbs, Austria aut NATIONALLICENCE 700 1- Staudinger Thomas Department of Internal Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna, Austria aut NATIONALLICENCE 700 1- Presterl Elisabeth Clinical Institute of Hospital Hygiene, Medical University of Vienna, Vienna, Austria aut NATIONALLICENCE 773 0- Wiener klinische Wochenschrift Springer Vienna 127/3-4(2015-02-01), 132-142 0043-5325 127:3-4<132 2015 127 508