Candida colonization as a predictor of invasive candidiasis in non-neutropenic ICU patients with sepsis: A systematic review and meta-analysis.
Int J Infect Dis. 2020 Nov 03;:
Authors: Alenazy H, Alghamdi A, Pinto R, Daneman N
BACKGROUND: Candida colonization is a risk factor for the development of invasive candidiasis. We sought to estimate the magnitude of this association, and determine if this information can be used to guide empiric antifungal therapy initiation in critically ill septic patients.
METHODS: We systematically reviewed PubMed/MEDLINE and Embase for all published studies evaluating predictors of invasive candidiasis in ICU patients with sepsis. We used meta-analysis to determine pooled odds ratio for invasive candidiasis among colonized versus non-colonized patients. We then calculated sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (+LR, -LR), 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 to 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 empiric antifungal treatment in non-neutropenic septic patients without prior documented candida colonization.
PMID: 33157294 [PubMed - as supplied by publisher]