{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:20:40Z","timestamp":1787728840298,"version":"build-2784847793"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Mycoses"],"published-print":{"date-parts":[[2026,8]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Candidaemia remains a common, life\u2010threatening infection among intensive care unit (ICU) patients, with high mortality, particularly in patients with delayed diagnosis and treatment.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n This international, multicentre, prospective, observational study aimed to identify risk factors for candidaemia in ICU patients and to develop an easy\u2010to\u2010use predictive tool, the CanDi\u2010Score, for early initiation of empirical antifungal treatment.<\/jats:p>\n <\/jats:sec>\n \n Patients\/Methods<\/jats:title>\n All adults over 18\u2009years hospitalised for more than 48\u2009h in the ICUs were included in the study and followed for 30\u2009days. Data on demographics, comorbidities, clinical severity scores including APACHE II and SOFA scores, Charlson comorbidity index (CCI), established risk factors for candidaemia and their time\u2010dependent effects such as total parenteral nutrition (TPN), mechanical ventilation (MV), and central venous catheter (CVC) were collected. Univariate and multivariate logistic regression analyses were used to identify factors associated with candidaemia development, and fast backwards variable selection was used. To account for between\u2010centre heterogeneity, sensitivity analyses were performed using mixed\u2010effects logistic regression models including centre\u2010specific random intercepts. A nomogram model was constructed using independent risk factors identified in multivariable analysis, and its predictive performance was evaluated with Area Under the Curve (AUC), sensitivity, and specificity.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 2,704 ICU patients, including 204 with candidaemia, were enrolled. Patients with candidaemia had higher APACHE II (19 vs. 13) and CCI scores (6 vs. 5; both\n p<\/jats:italic>\n \u2009<\u20090.001), and more frequently had chronic renal failure, haemodialysis, malignancy, recent gastrointestinal surgery, and neutropenia (all\n p<\/jats:italic>\n \u2009\u2264\u20090.05). Patients were randomly split into development (80%) and validation (20%) cohorts. Multivariate analysis identified higher CCI, concurrent infection, neutropenia, ICU stay >\u200914\u2009days, MV >\u20093\u2009days, CVC duration and TPN >\u200914\u2009days as independent risk factors. The risk associated with CVC increased substantially with prolonged use (OR: 0\u20137\u2009days: 3.69; 8\u201321\u2009days: 8.58; >\u200921\u2009days: 17.21). The model demonstrated good performance in both the development and validation cohorts, with sensitivity, specificity, and AUC values of 79.6%, 76.5%, and 0.86 (95% CI: 0.83\u20130.88) in the development cohort, respectively, and comparable predictive performance in the validation cohort. The score model was demonstrated by a nomogram.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Given the high mortality of candidaemia in ICU patients, the CanDi\u2010Score may serve as a valuable tool for early prediction and timely empirical antifungal treatment. Key predictors include CCI, presence of concurrent infections, the duration of CVC use, and TPN administration. CanDi\u2010Score provides clinicians with a practical approach to identify high\u2010risk patients and guides decision\u2010making for the early initiation of antifungal treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/myc.70213","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T10:49:17Z","timestamp":1787309357000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of Candidaemia Score (\n CanDi<\/scp>\n \u2010Score) in Decision of Early Empirical Antifungal Treatment for Patients in Intensive Care Unit: The International Prospective Observational\n ID<\/scp>\n \u2010\n IRI<\/scp>\n Study"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5225-8319","authenticated-orcid":false,"given":"Bircan","family":"Kayaaslan","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Yildirim Beyazit University Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halime","family":"Araz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice Ya\u011fmur","family":"Zengin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Hacettepe University Faculty of Medicine Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3155-4036","authenticated-orcid":false,"given":"Rukiyye","family":"Bulut","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Necmettin Erbakan University Faculty of Medicine Konya T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Oktay","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4689-720X","authenticated-orcid":false,"given":"Meltem","family":"Tasbakan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ege University Faculty of Medicine Izmir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sumeyra","family":"Istek","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ege University Faculty of Medicine Izmir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif Doyuk","family":"Kartal","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Eskisehir Osmangazi University Faculty of Medicine Eskisehir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Bayrak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Bursa Ilker Celikcan Physical Therapy Hospital Bursa T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Kaya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Yildirim Beyazit University Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma","family":"Eser","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Yildirim Beyazit University Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P\u0131nar Yuruk","family":"Atasoy","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice Esranur","family":"K\u0131ratl\u0131","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Karaman Training and Research Hospital Karaman T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berfin Cirkin","family":"Doruk","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Mersin City Training and Research Hospital Mersin T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3428-6137","authenticated-orcid":false,"given":"Mustafa","family":"Uguz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Mersin City Training and Research Hospital Mersin T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-8547","authenticated-orcid":false,"given":"Sema","family":"Sar\u0131","sequence":"additional","affiliation":[{"name":"Intensive Care Unit Nigde Training and Research Hospital Nigde T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0939-8049","authenticated-orcid":false,"given":"Bahar Busra","family":"Sivrikaya","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Samsun Training and Research Hospital Samsun T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"Akkoyunlu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Bezmialem Vakif University Faculty of Medicine Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lutfiye Nilsun","family":"Altunal","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Umraniye Training and Research Hospital, University of Health Sciences Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayse","family":"Albayrak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ataturk University Faculty of Medicine Erzurum T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Handan","family":"Alay","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ataturk University Faculty of Medicine Erzurum T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulsen","family":"Iskender","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elkholy","family":"Amani","sequence":"additional","affiliation":[{"name":"Department of Clinical Pathology and Microbiology Cairo University Hospitals Giza Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylan","family":"Onder","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Kadirli State Hospital Osmaniye T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilek","family":"Ozcengiz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation Cukurova University Faculty of Medicine Adana T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mediha","family":"Turktan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation Cukurova University Faculty of Medicine Adana T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihalj","family":"Mirko","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Reanimatology and Intensive Medicine School of Medicine, University of Mostar Mostar Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4440-335X","authenticated-orcid":false,"given":"Ilad Alavi","family":"Darazam","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Tropical Medicine Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences Tehran Iran"},{"name":"Infectious Diseases and Tropical Medicine Research Center Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0229-575X","authenticated-orcid":false,"given":"Mohammad Mehdi","family":"Shadravan","sequence":"additional","affiliation":[{"name":"Student Research Committee, Shahid Beheshti University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza Yahyavi","family":"Sahzabi","sequence":"additional","affiliation":[{"name":"Students' Scientific Research Center Tehran University of Medical Sciences Tehran Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4727-3239","authenticated-orcid":false,"given":"Ahmet Cem","family":"Yard\u0131mc\u0131","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology VM Medical Park Mersin Hospital Mersin T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruveyda","family":"Korkmazer","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Karabuk University Training and Research Hospital, Faculty of Medicine Karabuk T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunes","family":"Senol","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Izmir Bakircay University Faculty of Medicine Izmir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuba","family":"Kuruoglu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ondokuz Mayis University Faculty of Medicine Samsun T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih","family":"Temocin","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ondokuz Mayis University Faculty of Medicine Samsun T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Al\u0131c\u0131","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Yeditepe University Faculty of Medicine Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meral","family":"Sonmezoglu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Yeditepe University Faculty of Medicine Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aliye","family":"Esmaoglu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Erciyes University Faculty of Medicine Kayseri T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6895-0318","authenticated-orcid":false,"given":"Zeynep","family":"Ture","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Private Gurlife Hospital Eskisehir T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cortegiani","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.) University of Palermo Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozay","family":"Aky\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Adana City Hospital Adana T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatice Rahmet","family":"Guner","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Ankara Yildirim Beyazit University Ankara Bilkent City Hospital Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Erdem","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Clinical Microbiology Gulhane School of Medicine, University of Health Sciences Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-014-3310-z"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-004-1104-x"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.4161\/viru.26187"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0039-1693704"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2017.04.010"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit006"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199412000-00008"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000202208.37364.7D"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-007-0270-z"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-018-1162-0"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13258"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq147"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1590\/0037-8682-0292-2014"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ933"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00749-7"},{"issue":"12","key":"e_1_2_11_19_1","article-title":"Corticosteroids for pneumonia","volume":"12","author":"Stern A.","year":"2017","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens14080806"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-025-08849-9"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-023-06823-6"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2021.06.018"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1128\/aac.00358-25"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.2478\/abm-2024-0016"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13431"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13531"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3390\/jof11030204"}],"container-title":["Mycoses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/myc.70213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/myc.70213","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/myc.70213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:31:23Z","timestamp":1787725883000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/myc.70213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":27,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/myc.70213"],"URL":"https:\/\/doi.org\/10.1111\/myc.70213","archive":["Portico"],"relation":{},"ISSN":["0933-7407","1439-0507"],"issn-type":[{"value":"0933-7407","type":"print"},{"value":"1439-0507","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-02-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70213"}}