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dc.contributor.authorPlayford, EG
dc.contributor.authorLipman, J
dc.contributor.authorJones, M
dc.contributor.authorLau, AF
dc.contributor.authorKabir, M
dc.contributor.authorChen, SCA
dc.contributor.authorMarriott, DJ
dc.contributor.authorSeppelt, I
dc.contributor.authorGottlieb, T
dc.contributor.authorCheung, W
dc.contributor.authorIredell, JR
dc.contributor.authorMcBryde, ES
dc.contributor.authorSorrell, TC
dc.date.accessioned2019-09-30T04:07:14Z
dc.date.available2019-09-30T04:07:14Z
dc.date.issued2016
dc.identifier.issn1058-4838
dc.identifier.doi10.1093/cid/ciw610
dc.identifier.urihttp://hdl.handle.net/10072/387933
dc.description.abstractBackground. Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk. Methods. A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived. Results. Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%). Conclusions. Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests.
dc.description.peerreviewedYes
dc.languageEnglish
dc.language.isoeng
dc.publisherOxford University Press (OUP)
dc.relation.ispartofpagefrom1463
dc.relation.ispartofpageto1469
dc.relation.ispartofissue11
dc.relation.ispartofjournalClinical Infectious Diseases
dc.relation.ispartofvolume63
dc.subject.fieldofresearchBiological Sciences
dc.subject.fieldofresearchMedical and Health Sciences
dc.subject.fieldofresearchcode06
dc.subject.fieldofresearchcode11
dc.subject.keywordscandidemia
dc.subject.keywordscritical care
dc.subject.keywordsinvasive candidiasis
dc.subject.keywordsprophylaxis
dc.subject.keywordsrisk prediction
dc.titleProblematic dichotomization of risk for Intensive Care Unit (ICU)-acquired invasive candidiasis: Results using a risk-predictive model to categorize 3 levels of risk from a multicenter prospective cohort of Australian ICU patients
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationPlayford, EG; Lipman, J; Jones, M; Lau, AF; Kabir, M; Chen, SCA; Marriott, DJ; Seppelt, I; Gottlieb, T; Cheung, W; Iredell, JR; McBryde, ES; Sorrell, TC, Problematic dichotomization of risk for Intensive Care Unit (ICU)-acquired invasive candidiasis: Results using a risk-predictive model to categorize 3 levels of risk from a multicenter prospective cohort of Australian ICU patients, Clinical Infectious Diseases, 2016, 63 (11), pp. 1463-1469
dcterms.dateAccepted2016-08-29
dc.date.updated2019-09-30T04:06:14Z
gro.hasfulltextNo Full Text
gro.griffith.authorPlayford, Elliott G.


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