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Improvement of a clinical prediction rule for clinical trials on prophylaxis for invasive candidiasis in the intensive care unit
Author(s) -
OstroskyZeichner Luis,
Pappas Peter G.,
Shoham Shmuel,
Reboli Annette,
Barron Michelle A.,
Sims Charles,
Wood Craig,
Sobel Jack D.
Publication year - 2011
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/j.1439-0507.2009.01756.x
Subject(s) - mechanical ventilation , medicine , clinical prediction rule , intensive care unit , incidence (geometry) , intensive care medicine , central venous catheter , intensive care , retrospective cohort study , clinical trial , risk factor , emergency medicine , catheter , surgery , physics , optics
Summary We created a clinical prediction rule to identify patients at risk of invasive candidiasis (IC) in the intensive care unit (ICU) ( Eur J Clin Microbiol Infect Dis 2007; 26 :271). The rule applies to <10% of patients in ICUs. We sought to create a more inclusive rule for clinical trials. Retrospective review of patients admitted to ICU ≥ 4 days, collecting risk factors and outcomes. Variations of the rule based on introduction of mechanical ventilation and risk factors were assessed. We reviewed 597 patients with a mean APACHE II score of 14.4, mean ICU stay of 12.5 days and mean ventilation time of 10.7 days. A variation of the rule requiring mechanical ventilation AND central venous catheter AND broad spectrum antibiotics on days 1–3 AND an additional risk factor applied to 18% of patients, maintaining the incidence of IC at 10%. Modification of our original rule resulted in a more inclusive rule for studies.