Predicting invasive fungal disease due to Candida species in non-neutropenic, critically ill, adult patients in United Kingdom critical care units View Full Text


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Article Info

DATE

2016-09-09

AUTHORS

Jason Shahin, Elizabeth J. Allen, Krishna Patel, Hannah Muskett, Sheila E. Harvey, Jonathan Edgeworth, Christopher C. Kibbler, Rosemary A. Barnes, Sharmistha Biswas, Neil Soni, Kathryn M. Rowan, David A. Harrison,

ABSTRACT

BACKGROUND: Given the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis. METHODS: Data on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the Fungal Infection Risk Evaluation (FIRE) Study. Three risk prediction models were developed to model the risk of subsequent Candida IFD based on information available at three time points: admission to the critical care unit, at the end of 24 h and at the end of calendar day 3 of the critical care unit stay. The final model at each time point was evaluated in the three external validation samples. RESULTS: Between July 2009 and April 2011, 60,778 admissions from 96 critical care units were recruited. In total, 359 admissions (0.6 %) were admitted with, or developed, Candida IFD (66 % Candida albicans). At the rate of candidaemia of 3.3 per 1000 admissions, blood was the most common Candida IFD infection site. Of the initial 46 potential variables, the final admission model and the 24-h model both contained seven variables while the end of calendar day 3 model contained five variables. The end of calendar day 3 model performed the best with a c index of 0.709 in the full validation sample. CONCLUSIONS: Incidence of Candida IFD in UK critical care units in this study was consistent with reports from other European epidemiological studies, but lower than that suggested by previous hospital-wide surveillance in the UK during the 1990s. Risk modeling using classical statistical methods produced relatively simple risk models, and associated clinical decision rules, that provided acceptable discrimination for identifying patients at 'high risk' of Candida IFD. TRIAL REGISTRATION: The FIRE Study was reviewed and approved by the Bolton NHS Research Ethics Committee (reference: 08/H1009/85), the Scotland A Research Ethics Committee (reference: 09/MRE00/76) and the National Information Governance Board (approval number: PIAG 2-10(f)/2005). More... »

PAGES

480

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12879-016-1803-9

DOI

http://dx.doi.org/10.1186/s12879-016-1803-9

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1002469360

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27612566


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28 schema:description BACKGROUND: Given the predominance of invasive fungal disease (IFD) amongst the non-immunocompromised adult critically ill population, the potential benefit of antifungal prophylaxis and the lack of generalisable tools to identify high risk patients, the aim of the current study was to describe the epidemiology of IFD in UK critical care units, and to develop and validate a clinical risk prediction tool to identify non-neutropenic, critically ill adult patients at high risk of IFD who would benefit from antifungal prophylaxis. METHODS: Data on risk factors for, and outcomes from, IFD were collected for consecutive admissions to adult, general critical care units in the UK participating in the Fungal Infection Risk Evaluation (FIRE) Study. Three risk prediction models were developed to model the risk of subsequent Candida IFD based on information available at three time points: admission to the critical care unit, at the end of 24 h and at the end of calendar day 3 of the critical care unit stay. The final model at each time point was evaluated in the three external validation samples. RESULTS: Between July 2009 and April 2011, 60,778 admissions from 96 critical care units were recruited. In total, 359 admissions (0.6 %) were admitted with, or developed, Candida IFD (66 % Candida albicans). At the rate of candidaemia of 3.3 per 1000 admissions, blood was the most common Candida IFD infection site. Of the initial 46 potential variables, the final admission model and the 24-h model both contained seven variables while the end of calendar day 3 model contained five variables. The end of calendar day 3 model performed the best with a c index of 0.709 in the full validation sample. CONCLUSIONS: Incidence of Candida IFD in UK critical care units in this study was consistent with reports from other European epidemiological studies, but lower than that suggested by previous hospital-wide surveillance in the UK during the 1990s. Risk modeling using classical statistical methods produced relatively simple risk models, and associated clinical decision rules, that provided acceptable discrimination for identifying patients at 'high risk' of Candida IFD. TRIAL REGISTRATION: The FIRE Study was reviewed and approved by the Bolton NHS Research Ethics Committee (reference: 08/H1009/85), the Scotland A Research Ethics Committee (reference: 09/MRE00/76) and the National Information Governance Board (approval number: PIAG 2-10(f)/2005).
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35 schema:keywords A Research Ethics Committee
36 Bolton NHS Research Ethics Committee
37 Candida IFD
38 Candida IFD infection site
39 Candida species
40 Committee
41 Ethics Committee
42 European epidemiological studies
43 Fungal Infection Risk Evaluation (FIRE) Study
44 IFD infection site
45 Infection Risk Evaluation (FIRE) Study
46 Information Governance Board
47 Kingdom critical care units
48 NHS Research Ethics Committee
49 National Information Governance Board
50 Research Ethics Committee
51 Risk Evaluation study
52 Scotland A Research Ethics Committee
53 UK
54 UK critical care units
55 United Kingdom critical care units
56 acceptable discrimination
57 admission
58 admission model
59 adult patients
60 adults
61 aim
62 antifungal prophylaxis
63 benefits
64 blood
65 board
66 calendar day 3
67 calendar day 3 model
68 candidaemia
69 care unit
70 care unit stay
71 classical statistical methods
72 clinical decision rule
73 clinical risk prediction tools
74 common Candida IFD infection site
75 consecutive admissions
76 critical care unit stay
77 critical care units
78 current study
79 data
80 day 3
81 day 3 model
82 decision rules
83 discrimination
84 disease
85 end
86 epidemiological studies
87 epidemiology
88 epidemiology of IFD
89 evaluation study
90 external validation sample
91 factors
92 final admission model
93 final model
94 fire studies
95 full validation sample
96 fungal diseases
97 general critical care units
98 generalisable tools
99 governance boards
100 high risk
101 high-risk patients
102 hospital-wide surveillance
103 ill adult patients
104 ill population
105 incidence
106 index
107 infection site
108 information
109 invasive fungal disease
110 lack
111 method
112 model
113 modeling
114 non-immunocompromised adults
115 outcomes
116 patients
117 point
118 population
119 potential benefits
120 potential variables
121 prediction model
122 prediction tools
123 predominance
124 previous hospital-wide surveillance
125 prophylaxis
126 rate
127 rate of candidaemia
128 report
129 risk
130 risk factors
131 risk model
132 risk modeling
133 risk patients
134 risk prediction model
135 risk prediction tools
136 rules
137 samples
138 simple risk model
139 sites
140 species
141 statistical methods
142 stay
143 study
144 subsequent Candida IFD
145 surveillance
146 time points
147 tool
148 unit stay
149 units
150 validation sample
151 variables
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