• Cristóbal León, Sergio Ruiz-Santana, Pedro Saavedra, Beatriz Galván, Armando Blanco, Carmen Castro, Carina Balasini, Aránzazu Utande-Vázquez, Francisco J González de Molina, Miguel A Blasco-Navalproto, Maria J López, Pierre Emmanuel Charles, Estrella Martín, María Adela Hernández-Viera, and Cava Study Group.
• Intensive Care Unit (CL), Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain.
• Crit. Care Med. 2009 May 1;37(5):1624-33.

ObjectiveTo assess the usefulness of the "Candida score" (CS) for discriminating between Candida species colonization and invasive candidiasis (IC) in non-neutropenic critically ill patients. A rate of IC <5% in patients with CS <3 was the primary end point.DesignProspective, cohort, observational study.SettingThirty-six medical-surgical intensive care units of Spain, Argentina, and France.PatientsA total of 1,107 non-neutropenic adult intensive care unit patients admitted for at least 7 days between April 2006 and June 2007.Measurements And Main ResultsClinical data, surveillance cultures for fungal growth, and serum levels of (1-3)-beta-d-glucan and anti-Candida antibodies (in a subset of patients) were recorded. The CS was calculated as follows (variables coded as absent = 0, present = 1): total parenteral nutrition x1, plus surgery x1, plus multifocal Candida colonization x1, plus severe sepsis x2. A CS >or=3 accurately selected patients at high risk for IC. The colonization index was registered if >or=0.5. The rate of IC was 2.3% (95% confidence interval [CI] 1.06-3.54) among patients with CS <3, with a linear association between increasing values of CS and IC rate (p ConclusionsIn this cohort of colonized patients staying >7 days, with a CS <3 and not receiving antifungal treatment, the rate of IC was <5%. Therefore, IC is highly improbable if a Candida-colonized non-neutropenic critically ill patient has a CS <3.

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