The Application Of Corrected Colonization Index In The Preemptive Treatment For Candida Infection In Critically Ill Patients After Surgical Removal Of Digestive Tumor

ObjectiveThis research aims to evaluate preemptive treatment for candida infection (ICI) with reference of corrected colonization index(CCI) in critically ill patients with high risk factors of candida infection, to collect the epidemiology data of candida infection, to evaluate its feasibility, safety and reliability, and acquire the high risk factors of severe colonization.MethodsOne hundred and twenty critically ill patients after surgical removal of digestive tumor with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score>10were selected from intensive care unit (ICU) of Tianjin Medical University Cancer Institute and Hospital from January Ist2010to December31th2011, and they were randomly divided into two groups:CCI group and control group(60cases in each group). CC1was monitored in all patients. In control group the responsible intensivists ordered the treatment according to their own experience, and in CCI group, when the patient’s CCI>0.4and with evidence of sepsis, the patients were given anti-Candida immediately. When CCI<0.4, anti-candida treatment was not giyen. But when the patients’condition became worse or unstable, complementary anti-candida treatment was given.ResultsThere were no significant differences in general data, treatment of diseases of the patients, APACHE Ⅱ scores, length of ICU stay (LOS) between two groups(P>0.05). There were23patients and33patients developing sepsis in control group and CCI group, respectively. In CCI group, the time between the onset of sepsis to beginning of anti-candida treatment was significantly shorter than the control group (0.92±0.58) days vs.(3.53±3.41)days, P<0.05. In the group of CCI>0.4(39patients) the LOS[(13.72±12.62)days]and the incidence of failure in establishing enteral nutrition(82.05%)were significantly higher than that of the group of CCI<0.4[81patients,(7.10±8.65) days,18.52%, P<0.05].There was no significant difference in APACHE Ⅱ scores, incidence of mechanical ventilation and blood purification between two groups. Analysis of600strains of candida colonized in120patients, revealed that C. albicans ranked first(55.09%), C. glabrata ranked second(10.18%),followed by C. tropicalis, C. Seaver and Cryptococcus. Long term corticosteroid medication history and not carrying out enteral nutrition are the risk factors of severe colonization of candida.ConclusionApplication of CCI may enhance the accuracy of timely preemptive treatment for ICI, and facilitate the collection of epidemiological data of candida in critically ill patients after surgical removal of digestive tumor.