Application of a new Candida score for early antifungal treatment in an adult medical – surgical critical care unit

Introduction

The incidence of infections caused by Candida species in critical care has substantially increased in recent years. Recently, Candida infections have been increasing especially in critical care patients. Invasive candidiasis has been associated with severe sepsis, septic shock and multiple organ failure. With a clinical scenario very similar to bacterial infections, this infection is a diagnostic challenge with an estimated mortality rate of 40%.

Objective

To evaluate the impact of a Candida score on early antifungal treatment in a general critical care unit.

Methods

The Candidemia incidence rate ratio from July to December 2005 was compared with the same period in 2006 after the implementation of a Candida score system (Software Stata 8.0). Surveillance cultures of urine, tracheal and digestive samples from each patient were obtained weekly. According to Leon and colleagues [1], patients with at least two positive sites and sepsis or with total parenteral nutrition or a recent surgical intervention received antifungal treatment (fluconazole or Caspofungin) – preemptive treatment. The incidence after the Candida score implementation was reduced from 1.91 (2/1,049 patient-days) to 0.92 (1/1,081 patient-days) with no statistical significance (P = 0.3).

Conclusion

In this preliminary report, the Candida score seems to be a helpful tool to reduce the incidence of Candida infections in a general critical care unit. In a large population, the use of the Candida score system may assist in identifying candidates for preemptive antifungal treatment among the critical care population.