A prospective multi-centre study assessing the usefulness of CS for discriminating between candida spp. colonisation versus invasive candidiasis (IC) in non neutropenic and critically ill patients, enrolled 1107 patients admitted for at least 7 days.
Fungal diagnosis was confirmed based on cultures, serum 1-3-beta-D-glucan adn anti-candida antibodies (some patients).
Score: (0 = absent, 1 = present)
TPN 1
Surgery 1
Multifocal colonisation 1
Severe sepsis 2
CS >3 is at increased risk of IC (8.5%); with sensitivity 77.6% and specificity 66.2%, Positive predictive value 13.8%, and negative predictive value 97.7%.
Early antifungal therapy may be considered.
Risks of higher scores: 4 (16.8%); 5 (23.6%).
Risk is 2.3% only, if score <3 and author concludes that IC is highly improbable in such patients.
http://www.ncbi.nlm.nih.gov/pubmed/19325481
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