Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis. (January 2021)

• Record Type: Journal Article
• Authors: Alenazy, Hameid; Alghamdi, Amenah; Pinto, Ruxandra; Daneman, Nick
• Is Part Of: International journal of infectious diseases. Volume 102(2021)
• Page Start: 357
• Page End: 362
• Publication Date: 2021-01
• Subjects: Candidemia -- Invasive candidiasis -- Candida colonization -- ICU; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.10.092
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Candida colonization is associated with an increased chance of invasive Candida infection as a cause of sepsis in critically ill patients. A lack of history of Candida colonization is helpful to rule out Candida as a cause of sepsis. A history of Candida colonization has a low positive predictive value for ruling in Candida as a cause of sepsis. Abstract: Background: Candida colonization is a risk factor for the development of invasive candidiasis. This study sought to estimate the magnitude of this association, and determine if this information can be used to guide empirical antifungal therapy initiation in critically ill septic patients. Methods: PubMed/MEDLINE and Embase were systematically reviewed for all published studies evaluating predictors of invasive candidiasis in ICU patients with sepsis. Meta-analysis was used to determine the pooled odds ratio for invasive candidiasis among colonized versus non-colonized patients. Sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (+LR, ―LR) were then calculated by considering the presence/absence of Candida colonization as the diagnostic test, and the presence/absence of invasive candidiasis as the disease of interest. Results: Out of 9825 patients in the 10 eligible studies, 3886 (40%) were colonized with Candida and 462 patients (4.7%) developed invasive candidiasis. Meta-analysis indicated that critically ill patients with sepsis who are colonized with candida are more likely to develop invasive candidiasis (odds ratio 3.32; 95% CI 1.68–6.58) compared with non-colonized patients. The pooled SN was 75.2% (95% CI 59.6–86.2%), while the pooled SP was 49.2% (95% CI 33.2–65.3%).The NPV of Candida colonization was high (96.9%; 95% CI 92.0–98.9%), but the PPV was low (9.1%; 95% CI 5.5–14.6%). Conclusion: Candida colonization is strongly associated with the likelihood of invasive candidiasis among ICU patients with sepsis. Available data argue against initiating empirical antifungal treatment in non-neutropenic septic patients without prior documented Candida colonization.