A simple prediction score for estimating the risk of candidaemia caused by fluconazole non-susceptible strains

G. Cuervo, M. Puig-Asensio, C. Garcia-Vidal, M. Fernández-Ruiz, J. Pemán, M. Nucci, J. M. Aguado, M. Salavert, F. González-Romo, J. Guinea, O. Zaragoza, C. Gudiol, J. Carratalà, B. Almirante, Belén Padilla, Patricia Muñoz, Jesús Guinea, José Ramón Paño, Julio García, Carlos GarcíaJesús Fortún, Pilar Martín, Elia Gómez, Pablo Ryan, Carolina Campelo, Ignacio de los Santos, Buenaventura Buendía, Beatriz Pérez, Mercedes Alonso, Francisca Sanz, José María Aguado, Paloma Merino, Fernando González, Miguel Gorgolas, Ignacio Gadea, Juan Emilio Losa, Alberto Delgado-Iribarren, Antonio Ramos, Yolanda Romero, Isabel Sánchez, Oscar Zaragoza, Manuel Cuenca-Estrella, Jesús Rodríguez-Baño, Ana Isabel Suarez, Ana Loza, Ana Isabel Aller, Estrella Martín-Mazuelos, Maite Ruiz, José Garnacho-Montero, Carlos Ortiz, Mónica Chávez, Fernando L. Maroto, Miguel Salavert, José Blanquer, David Navarro, Juan José Camarena, Rafael Zaragoza, Vicente Abril, Concepción Gimeno, Silvia Hernáez, Guillermo Ezpeleta, Elena Bereciartua, José L. Hernández, Miguel Montejo, Rosa Ana Rivas, Rafael Ayarza, Ana Ma Planes, Isabel Ruiz-Camps, Benito Almirante, José Mensa, Manel Almela, Mercè Gurgui, Ferran Sánchez-Reus, Joaquín Martínez-Montauti, Montserrat Sierra, Juan Pablo Horcajada, Luisa Sorli, Julià Gómez, Amadeu Gené, Mireia Urrea, C. Garcia-Vidal, Josefina Ayats, Carlota Gudiol, Jordi Carratalà, Marcio Nucci, Mora Obed, Adriana Manzur

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Abstract

© 2015 European Society of Clinical Microbiology and Infectious Diseases. We aimed to develop a simple prediction score to identify fluconazole non-susceptible (Flu-NS) candidaemia using simple clinical criteria. A derivation cohort was extracted from the CANDIPOP study, a prospective, multicentre, population-based surveillance programme on candidaemia conducted in 29 hospitals in Spain from April 2010 to May 2011. The score was validated with an external, multicentre cohort of adults with candidaemia in six tertiary hospitals in three countries. The prediction score was based on three variables selected by a logistic regression model together with the severity of disease. In total, 617 and 297 cases of candidaemia were included in the derivation and validation cohorts, respectively; of these, 134 (21.7%) and 57 (19.2%) were caused by Flu-NS strains. Factors independently associated with Flu-NS were transplant recipient status (adjusted odds ratio (AOR) 2.13; 95% CI 1.01-4.55; p 0.047), hospitalization in a unit with a high prevalence (≥15%) of Flu-NS strains (7.53; 4.68-12.10; p<0.001), and previous azole therapy for at least 3 days (2.04; 1.16-3.62; p 0.014). The area under the receiver operating characteristics curve (AUC) was 0.76 (0.72-0.81), and using 2 points as the Flu-NS prediction score cut-off gave a sensitivity of 82.1%, a specificity of 65.6%, and a negative predictive value of 93%. The AUC in the validation cohort was 0.72 (95% CI 0.65-0.79). Hence, the Flu-NS prediction score helped to exclude Flu-NS Candida strains. This could improve the selection of empirical treatments for candidaemia in the future.
Original languageEnglish
Pages (from-to)684.e1-684.e9
JournalClinical Microbiology and Infection
Volume21
Issue number7
DOIs
Publication statusPublished - 1 Jul 2015

Keywords

  • C. glabrata
  • Candidaemia
  • Fluconazole non-susceptible
  • Prediction score
  • Treatment

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    Cuervo, G., Puig-Asensio, M., Garcia-Vidal, C., Fernández-Ruiz, M., Pemán, J., Nucci, M., Aguado, J. M., Salavert, M., González-Romo, F., Guinea, J., Zaragoza, O., Gudiol, C., Carratalà, J., Almirante, B., Padilla, B., Muñoz, P., Guinea, J., Paño, J. R., García, J., ... Manzur, A. (2015). A simple prediction score for estimating the risk of candidaemia caused by fluconazole non-susceptible strains. Clinical Microbiology and Infection, 21(7), 684.e1-684.e9. https://doi.org/10.1016/j.cmi.2015.02.029