Candida colonization and subsequent infections in critically ill surgical patients

摘要: OBJECTIVE. The authors determined the role of Candida colonization in development subsequent infection critically ill patients. DESIGN. A 6-month prospective cohort study was given to patients admitted surgical and neonatal intensive care units a 1600-bed university medical center. METHODS. Patients having predetermined criteria for significant revealed by routine microbiologic surveillance cultures at different body sites were eligible study. Risk factors recorded. index daily as ratio number distinct (dbs) colonized with identical strains over total dbs tested; mean 5.3 per patient obtained. All isolates (n = 322) sequentially recovered characterized genotyping using contour-clamped homogeneous electrical field gel electrophoresis that allowed strain delineation among species. RESULTS. Twenty-nine met inclusion; all high risk infection; 11 (38%) developed severe infections (8 candidemia); remaining 18 heavily colonized, but never required intravenous antifungal therapy. Among potential candida infection, three discriminated from infected patients--i.e., length previous antibiotic therapy (p < 0.02), severity illness assessed APACHE II score 0.01), intensity spp 0.01). By logistic regression analysis, latter two who independent predicted candidal infection. always preceded genotypically strain. proposed indexes reached threshold values 6 days before demonstrated positive predictive (66 100%). CONCLUSIONS. systematic screening helps predicting Accurately identifying high-risk offers opportunity intervention strategies.