The deterministic effect of candida colonization index in the early diagnosis of candidal infection

Candidemia is associated with mortality, extends the duration of hospitalstay and increases the cost of medical care. The aim of this study is to investigatethe deterministic effect of candida colonization index in the early diagnosis ofcandidal infection in intensive care units (ICU).Mouth, axilla, NG, rectum, and urine culture samples taken fromreanimation and neurological intensive care unit (ICU) patients in GaziUniversity Faculty of Medicine between January 2006 and July 2007 wereretrospectively evaluated and CCI (ratio of the number of culture positivesurveillance sites for Candida spp. to the number of sites cultered) werecalculated.CCI reached 0,5 in the cultures of 29 patients. 29 patients developedcandidial infection; 27 (27/29) of them had CCI?0,5. 18 patients developedurinary infections, 11 patients developed candidemia 1 patient developed woundinfection. Increased age (? 65), length of hospital stay prior to ICU admission,stay in reanimation ICU stay, use of broad spectrum cephalosporins, renalfailure, loss of consciousness, central venous catheter, peripheral arterial catheterand intubation were observed to be predictors of colonization and candidialinfection. In contrast, use of sulbactam ampicillin was observed to be an inverse109predictive factor for colonization and prior bacterial urinary infections waspredictors of candidal infections. We found the use of peripheral arterial catheterto be directly and sulbactam-amphicilin to be directly and inversely proportionalindependent risk factors for colonization development. CCI was found the onlyindependent predictor for candidal infection. The positive predictive value,sensitivity, and specifity of CCI for the candidial infection was 93,10 %, 93,10%, and 96,22 %, respectively.We concluded that monitoring for CCI in patients with unaccountablefever, severe sepsis or septic shock offers prevention of candidal infection byearly diagnosis and intervention. Independently from the other risk factors, CCIcan be considered as an effective test for early diagnosis of invasive in ICUpatients.Key words: Candidal infections, Candida colonization index, intensive careunit