What is the Candida (fungal infection) score?

From the Guidelines

The Candida score is a crucial tool for identifying patients at high risk for invasive candidiasis, and a score of 3 or higher indicates a high risk, suggesting empirical antifungal therapy may be warranted, as supported by the 2016 update by the Infectious Diseases Society of America 1. The Candida score assigns points based on four risk factors: multifocal Candida colonization, surgery, total parenteral nutrition, and severe sepsis, with a maximum score indicating a higher risk of invasive candidiasis.

• Multifocal Candida colonization is assigned 1 point
• Surgery is assigned 1 point
• Total parenteral nutrition is assigned 1 point
• Severe sepsis is assigned 2 points A score of 3 or higher is associated with a high risk of invasive candidiasis, and empirical antifungal therapy should be considered in these patients, as the risk of mortality among patients with candidemia ranges from 10% to 47% 1. The use of the Candida score helps distinguish between simple colonization and invasive infection, reducing unnecessary antifungal use while ensuring treatment for high-risk patients, and regular reassessment of the score is recommended as patient conditions change during ICU stays. The biological rationale behind the score is that these risk factors create conditions favorable for Candida overgrowth and invasion, such as disrupted mucosal barriers from surgery, altered gut flora from antibiotics, and impaired immunity during severe sepsis, as discussed in the 2016 clinical practice guideline for the management of candidiasis 1. Early initiation of effective antifungal therapy and source control is critical in the successful treatment of candidemia, as demonstrated by data suggesting significantly higher mortality rates among patients with candidemia in whom antifungal therapy was delayed or considered inadequate, and/or in whom source control was not promptly attained 1. The echinocandins demonstrate significant fungicidal activity against most Candida species, and each of these agents has demonstrated success in approximately 70%–75% of patients in randomized, comparative clinical trials 1, making them a suitable choice for empirical antifungal therapy in high-risk patients.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Candida Score Overview

• The Candida score is a tool used to differentiate among ICU patients who exhibit hospital-acquired severe sepsis or septic shock, and to identify those who would benefit from early antifungal treatment 2.
• The score is calculated based on patient characteristics and clinical data, and a score > 3 indicates a high risk of invasive candidiasis 2.

Relationship Between Candida Score and Invasive Candidiasis

• Studies have shown that patients with a higher Candida score are more likely to develop invasive candidiasis 2, 3.
• A study found that the incidence of invasive candidiasis was 0% in patients with a score = 2 or 3,17.6% in patients with a score = 4, and 50% in patients with a score = 5 (p < 0.0001) 2.
• Another study found that all patients who developed invasive Candida infections had a Candida colonization index ≥ 0.5 and a Candida score ≥ 2.5 3.

Clinical Applications of the Candida Score

• The Candida score can be used to select patients at high risk of developing invasive Candida infections, who would benefit from the administration of systemic antifungal therapy 2, 3.
• The score can help physicians to initiate early antifungal treatment, which is essential for improving prognosis in patients with invasive candidiasis 2, 3.
• The Candida score can be used in conjunction with other clinical scoring systems, such as the Candida colonization index, to improve diagnosis and treatment of invasive Candida infections 3.