A simple prediction score for Estimating the Risk of candidemia caused by fluconazole non-susceptible strains.
Clin Microbiol Infect. 2015 Mar 9;
Authors: Cuervo G, Puig-Asensio M, Garcia-Vidal C, Fernández-Ruiz M, Pemán J, Nucci M, Aguado JM, Salavert M, González-Romo F, Guinea J, Zaragoza O, Gudiol C, Carratalà J, Almirante B, CANDIPOP project and the validation cohort project
BACKGROUND: We aimed to develop a simple prediction score to identify fluconazole non-susceptible (Flu-NS) candidemia using simple clinical criteria.
METHODS: A derivation cohort was extracted from the CANDIPOP study, a prospective, multicenter, population-based surveillance program on candidemia conducted in 29 hospitals in Spain from April 2010 to May 2011. The score was validated with an external, multicenter cohort of adults with candidemia in six tertiary hospitals in three countries. The prediction score was based on three variables selected by logistic regression model together with the severity of disease.
RESULTS: In total, 617 and 297 cases of candidemia were included in the derivation and validation cohorts, respectively; of these, 134 (21.7%) and 57 (19.2%) were caused by Flu-NS strains. Factors independently associated with Flu-NS were transplant recipient status (adjusted odds ratio [AOR], 2.13; 95% confidence interval [CI], 1.01-4.55; p = 0.047), hospitalization in a unit with a high prevalence (≥15%) of Flu-NS strains (7.53; 4.68-12.10; p < 0.001), and prior azole therapy for at least 3 days (2.04; 1.16-3.62; p = 0.014). The area under the receiver operating characteristics curve (AUC) was 0.76 (0.72-0.81), and using 2 points as the Flu-NS prediction score cut-off gave a sensitivity of 82.1%, a specificity of 65.6%, and a negative predictive value of 93%. The AUC in the validation cohort was 0.72 (95% CI, 0.65-0.79).
CONCLUSIONS: The Flu-NS prediction score helped to exclude Flu-NS Candida strains. This could improve the selection of empirical treatments for candidemia in the future.
PMID: 25765773 [PubMed - as supplied by publisher]