Risk factors for invasive Candida infection
Keighley, 2021Playford, 2016Thomas-Ruddel, 2022
Overlapping risk factors for invasive Candida infection and candidaemia have been described for the general hospital population and in the intensive care setting. Scoring systems to assess a patient’s risk of Candida infection have been developed but these have not been validated outside the intensive care setting, which limits their generalisability. In addition, the risk thresholds for starting empirical therapy in these scoring systems are not well defined.
Risk factors for invasive Candida infection lists predisposing factors and interventions that have been associated with invasive Candida infection in hospitalised adults. In patients with sepsis or septic shock, presence of these risk factors should guide whether empirical therapy for invasive Candida infection is required:
- Patients with one or two of the risk factors are at low risk of Candida infection and are least likely to benefit from empirical therapy for invasive Candida infection.
- Patients with multiple risk factors (in one study1, 6 or more) are at high risk of Candida infection and empirical therapy should be started.
- For patients who are at intermediate risk of invasive Candida infection, empirical treatment could be considered if there is also a high risk of mortality, especially patients: with septic shock; sepsis suspected to be from a gastrointestinal source; chronic cardiovascular or liver disease; or patients older than 65 years.
A patient with sepsis or septic shock who has any of the risk factors below is at increased risk of invasive Candida infection. Based on the number of risk factors present and the risk of mortality, patients are stratified into low risk, intermediate risk and high risk. Patients who have many risk factors are at a significantly increased risk, and empirical therapy may be requiredKeighley, 2021Playford, 2016Thomas-Ruddel, 2022.
Comorbidities
- chronic liver disease
- solid organ transplant
Current risk factors and interventions
- people who inject drugs
- central venous access device in situ
- moderate to severe neutropenia (less than 1.0 x 109 cells/L)
- receiving total parenteral nutrition
Risk factors or interventions within the last 30 days
- gastrointestinal or hepatobiliary surgery
- urological instrumentation (including indwelling urinary catheter)
- carbapenem use for more than 72 hours
- high-dose corticosteroid use in the last 7 days (equivalent to 50 mg prednisolone or more)
- receipt of blood transfusion
- culture of Candida from throat or urine (increased risk if both are positive)