Incidence of candidaemia and antifungal sensitivity in critically ill patients
Bibliographic record
Abstract
Candidaemia is increasing all over the world in recent years mainly in critically ill patients. Invasive candidiasis is becoming an important nosocomial infection. Bloodstream infections (BSIs) caused by Candida spp are a major cause of morbidity and mortality in immune-compromised hosts. The prevalence of fungal infections has progressively increased, because the population of immune-deficient subjects has expanded due to advances in supportive therapy as well as the number of elderly people in our society. In these patients, the most common infections caused by Candida spp are invasive candidiasis (IC) and candidaemia, \nThe incidence of IC was remarkably consistent in US increasing from 1979 to 2001 of about 300% in parallel with the increase of bacterial infections. The mortality rate resulted to be higher in candidaemia than in bacterial infection. C. albicans was the most frequently isolated fungal species with 43.6% of occurrence followed by C. glabrata ( 26.7%) , C.parapsilosis (16%) , C. tropicalis (10%) ,C. krusei (2%) etc. The distribution of Candida spp is quite different in US and in Europe. In Europe and in Canada, blood-stream infections by Candida are lower than that reported from United States where C. glabrata is the most frequent species among non-albicans Candida. \n The variation in the frequency of C. glabrata may depend on exposure to azoles especially fluconazole used in prophylaxis in high risk critically ill patients. In any case, a shift to non-albicans species and a growing resistance to the common antifungal drugs have been noticed over the last years. \nCandida spp is part of the normal flora of human skin and mucosa gastrointestinal tract: the species are differently distributed in the various districts of the organism. Based on experimental studies and using molecular biology techniques, it has been confirmed that the most frequent origins of candidaemia are the gastrointestinal tract (via bacterial translocation) and the skin (in critically ill patients with venous catheters). \nA model for IC can be explained through the insult on the epithelial cells of gastro-intestinal tract and the use of antibiotics affecting the normal intestinal flora. This may select Candida species promoting the infection , the following translocation from gastro-intestinal tract to bloodstream finally leading to the disseminated disease and eventual colonization of CVC. \nThe connection between intensive care unit (ICU) and fungal infections has been demonstrated in several studies (......). In case of critically ill patients admitted in an ICU, a lot of risk factors are involved such as underlying diseases, presence of venous catheters, parenteral nutrition, use of antibiotics , acute pancreatitis, abdominal surgery etc.. \nCandida colonization, defined as growth of yeast from non-sterile sites, is usually the first stage for most cases of invasive candidiasis in critically ill patients and it has been considered as an early marker of deep infection. Then previous colonization by Candida in non-sterile sites has been identified as a risk factor for invasive infection. In fact, 60-80% of patients with candidaemia were previously colonized by the same species.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".