A validated risk model based on these six discriminators (age <64 years, temperature <98��C, cachexia, previous hospitalization, admission from another healthcare facility, selleck chemicals 17-AAG and mechanical ventilation) may therefore provide early detection and subsequent early appropriate treatment of these high-risk patients, potentially improving outcome.Candidemia is the fourth most common bloodstream isolate in hospitalized patients and accounts for an increased length of stay and significant morbidity and mortality, ranging from 25 to 58% [2-4]. Many of these data have been evaluated in hospitalized patients, however, where the epidemiologic data and risk factor analysis have been more developed.

Other predictive scores have included candida colonization, parenteral nutrition, and antibacterial therapy – these factors are common in hospitalized intensive care unit patients, which constitute most cases of candidemia [5,6].Early-onset candidemia, as defined by a positive blood culture within 2 days of admission, is a less described entity. Shorr and colleagues, in another publication, have recently outlined the burden of early-onset candidemia, with a longer length of stay, higher crude mortality, and higher hospitalization cost when compared with bacterial bloodstream infections [7]. While the rates of candidemia remain low (1.3% of all bacteremia cases), certain high-risk patients have much higher rates approaching 27% as outlined in this study. Risk stratification by application of the validated risk model can have a profound impact on early therapy and intervention in these cases.

The role of early appropriate therapy has become important as inappropriate or delayed therapy leads to higher mortality [8-10]. In bacterial bloodstream infections and pneumonia, early identification of those at risk for multidrug-resistant organisms can lead to early appropriate therapy, and thus to a lower mortality [9]. In candidemia, studies have show that delayed therapy can lead to a higher mortality in hospitalized patients with late candidemia [11]. Early identification of these patients therefore becomes paramount. Since early-onset candidemia is an unusual presentation on hospitalization, a high potential for delayed therapy exists – even in the high-risk groups. While diagnostic biomarkers (��-D-glucan) have promise, blood cultures still remain the gold standard for diagnosis but take 24 to 72 hours for growth.Risk analysis models or scores have been used in the past for prophylaxis or empiric therapy for candidemia [5,6]. These scores have been in hospitalized patient populations, however, largely in the intensive care unit where candidemia is more prevalent. A risk factor model has not been used before in early-onset Brefeldin_A candidemia.