Early, rapid increase in risk factors predicts Candida infection in SICU patients

NEW YORK (Reuters Health) – The risk of colonization or infection by Candida can and should be assessed beginning on the first day a patient is admitted to a surgical intensive care unit (SICU), according to authors of a prospective, multicenter study. If risk factors are present, they say, physicians would be well advised to begin obtaining surveillance fungal cultures and consider empirical antifungal therapy.

Dr. Peggy S. McKinnon, of Wayne State University in Detroit, and associates assessed 301 consecutive patients who were admitted for at least 5 days to SICUs. Their assessment included a list of 23 risk factors for development of Candida infection most commonly reported in the literature. Data regarding demographics, APACHE II scores, and types of trauma or surgery were also collected.

Patients who developed disseminated infection had accumulated more than nine risk factors by day 4, the investigators report in the Archives of Surgery for December. However, those who never developed colonization averaged fewer than seven risk factors for all days except the 8th.

The risk factors for Candida shifted according to time patients remained in the SICU. On day 1, multiple surgical procedures, diarrhea, or the presence of a central catheter for longer than 72 hours independently and significantly predicted Candida colonization and disseminated infection. Other significant early risk factors included total parenteral nutrition, multiple SICU admissions, and mechanical ventilation.

Only later in the SICU stay did such factors as persistent hyper- or hypothermia, leukocytosis in the face of antibiotic therapy, continued mechanical ventilation, and broad spectrum antibiotic use predict risk of Candida.

APACHE II scores remained higher than 18 during the entire SICU stay in patients who developed Candida colonization or infection, but decreased significantly from baseline by day 3 in those who never exhibited colonization.

"Determining the change in Candida risk factors over time is potentially more clinically relevant than evaluating risk factors at any given point in time," the authors suggest.

Arch Surg 2001;136:1401-1409.

0 תגובות

השאירו תגובה

רוצה להצטרף לדיון?
תרגישו חופשי לתרום!

כתיבת תגובה

מידע נוסף לעיונך

כתבות בנושאים דומים