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Invited Critique
December 2001

Temporal Assessment of Candida Risk Factors in the Surgical Intensive Care Unit—Invited Critique

Arch Surg. 2001;136(12):1409. doi:10.1001/archsurg.136.12.1409

Intercurrent Candida infection complicates surgical critical care. The article by McKinnon and colleagues is an observational study of the risk factors for Candida colonization and infection among patients with an SICU length of stay exceeding 5 days. The authors conclude that patients who have higher numbers of risk factors at admission and accumulate higher numbers of those risk factors during the SICU stay are at higher risk for Candida infection.

The critical reader will note this is an observational study. There was no protocol for prophylaxis, no schedule for screening cultures, and no control of confounding variables. Figure 2 in their article suggests that the differences in risk factors may be present on admission since changes in risk factors among the groups seem to "track" in parallel following admission. Figure 1 suggests that patients who respond to critical care with objective improvement in their physiologic derangements are less likely to have Candida colonization or infection. The risk factors themselves are familiar, with multiple admissions, multiple invasions, and a shortfall in nutrition prominent among them.