Design and use of Candida scores at the intensive care unit

Invasive Candida infections are recognised as a cause of increased morbidity and mortality in intensive care patients, particularly those with recent extensive gastroabdominal surgery. Due to the difficulties of diagnosis, several authors have analysed risk factors suggestive of invasive candidiasis to identify patients at highest risk. Such patients may be potential candidates for preemptive antifungal therapy before becoming seriously ill. The extent of body site colonisation due to Candida species was recognised to be related with consequent invasive disease. The quantification of the colonisation was expressed as the Candida colonisation index. Based on the evaluation of independent risk factors predictive of invasive Candida infections, clinically relevant scores were evaluated in the last decade. Particularly, the Candida score that combines the clinical risk factors preceding surgery, total parenteral nutrition and severe sepsis with Candida multi-site colonisation can be considered a useful bedside scoring system to discern patients with mere Candida colonisation from patients with the risk of invasive candidiasis in non-neutropaenic critically ill patient population.