Abstract disseminated candidiasis with deep organ involvement, endocarditis and



Introduction: Candidasis
is a growing problem, particularly in hospital intensive care unit
(ICU).Currently, invasive candidiasis includes more than 17% of nosocomial
infections in patients admitted to the intensive care units, timely diagnosis
and treatment is life saving. Unfortunately current candida score based on
clinical indices, has low specificity.

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Goals: This
study suggests the development of a new scoring system taking into account all
risk factors for invasive candidate that will have better sensitivity and

Methods: The
ICU patients at risk of candida infections were identified using traditional
candida score. Then, candida culture test was performed for all of the patients
at risk since admission in ICU and once a week until discharge from the ICU or
death. The data were analyzed in a modified candida scoring system introduced
in this article, to compare of the specificity and sensitivity in tow scoring

Results: All
of the risk factors include Total Parenteral Nutrition (TPN),Central Venous
Catheter (CVC), Broad antibiotic therapy, abdominal surgery, ICU stay
days> 7, pancreatitis, were associated with candidiasis infection (p

2.5 was classed as a positive ‘Candida score’ which should identify patients
who would benefit from early antifungal treatment. Although candida scoring
system was successful in early diagnosis in previous studies, its potentials
should be evaluated in each community because many confounding factors such as
nutrition which are affecting patients’ life are different in societies.
Therefore we have conducted a survey on candida score comparing it with a new
scoring system named “Modified Candida Score” which is designed for ICU
patients in Masih Daneshvari hospital, Tehran, Iran to identify patients in
high risk of candida infection. It is expected that early diagnosis and
prophylaxis therapy release patients from disease and high costs of treatment. Risk
factors such as Total
Parenteral Nutrition, central
venous catheters, broad
antibiotic usage, abdominal surgery, pancreatitis, severe sepsis, ICU stay>7
days, cortico steroids therapy, immunosuppressive state, diabetes mellitus and
mechanical ventilation were examined to distinguish high risk patients. After
the risk factor assessment for “Modified Candida score”, sensitivity and
specificity of two methods were compared together.


Materials and

This was a prospective, cohort, observational study in intensive
care unit (ICU) of Masih Daneshvari hospital, from October 2012 to October
2013. All patients exhibiting, on ICU admission (medical and surgical) or
during their ICU stay (at least 7 days in ICU), hospital-acquired severe sepsis
or septic shock could be included in this study. Exclusion criteria were
community-acquired infections, age


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