[Use of the colonization index].

Area of Science:

• Medical Mycology
• Infectious Diseases
• Intensive Care Medicine

Background:

• Fungal colonization is a significant concern in intensive care units (ICUs), particularly in patients with digestive diseases.
• Early identification of patients at risk for fungal infections is crucial for timely intervention.

Purpose of the Study:

• To assess the feasibility, workload, and cost implications of monitoring fungal colonization using the Pittet index in an ICU setting.
• To evaluate the correlation between the Pittet index and the risk of Candida infection.

Main Methods:

• Retrospective analysis of 2,238 mycologic samples from 89 ICU patients over one year.
• Calculation and monitoring of the Pittet index.
• Assessment of direct pseudomycelium observation and candiduria as indicators of fungal colonization.

Main Results:

• The Pittet index effectively identified patients at high risk for Candida infection.
• Monitoring the Pittet index necessitated strong collaboration between ICU and mycology labs, increasing costs and workload.
• Treatment initiation based on a colonization index ≥ 0.5 with clinical signs led to increased antifungal drug expenditure.
• Direct pseudomycelium and candiduria correlated significantly with fungal colonization.

Conclusions:

• The Pittet index is a valuable tool for identifying high-risk patients for Candida infections in ICUs.
• Implementing Pittet index monitoring requires significant resources and interdepartmental coordination.
• Further studies are needed to evaluate the clinical benefits and cost-effectiveness of this monitoring strategy.