The Use of Candida Scoring as a Predictor for Candida Infection in Patients Admitted in the Intensive Care Units of a Tertiary Medical Center

Background: Candida infections range from oral candidiasis to candida endophthalmitis, peritonitis and candidemia. Invasive fungal disease or disseminated candidiasis is highly fatal among children. There are no studies done in the pediatric population to detect early candida infection to help identify those who will benefit from early and prompt medical treatment. Objective: This study determined the value of Candida scoring (CS) as a predictive tool for invasive candidiasis among pediatric patients admitted in the intensive care units of a tertiary referral center. Methods: This was a retrospective cross sectional study where 4184 charts of pediatric patients and admitted in the ICU between January 2018 to December 2020 were reviewed. Patients were scored upon admission, after 3 days, after 1 week and weekly thereafter until discharge or demise. The scoring tool used was developed by Leon et al., and uses four variables: presence of sepsis, use of total parenteral nutrition (TPN), presence of multifocal colonization and presence of surgery. Data collected for Candida scores were presented as frequencies and percentages. Results: There were 396 patients enrolled in this study and 25.7% were treated for candida infection. Majority were newborns where 78.7% had a CS >3, which is statistically significant, p =<0.001. Most patients with severe sepsis/septic shock (85%) had a CS of >3 which is statistically significant. Among intubated patients, 84% had a CS of >3 and all patients on TPN had a CS of >3, both of which are significant. CS could correctly predict 64.6% of patients who will likely have candida infection. Conclusion: Candida scoring is a tool that can be used in patients at high risk of developing Candida infection. In this study, a CS of >3 can be used to predict Candida infection in the ICU.