TY - JOUR

T1 - Guideline adherence and survival of patients with candidaemia in Europe

T2 - results from the ECMM Candida III multinational European observational cohort study

AU - Hoenigl, Martin

AU - Salmanton-García, Jon

AU - Egger, Matthias

AU - Gangneux, Jean-Pierre

AU - Bicanic, Tihana

AU - Arikan-Akdagli, Sevtap

AU - Alastruey-Izquierdo, Ana

AU - Klimko, Nikolai

AU - Barac, Aleksandra

AU - Özenci, Volkan

AU - Meijer, Eelco F. J.

AU - Khanna, Nina

AU - Bassetti, Matteo

AU - Rautemaa-Richardson, Riina

AU - Lagrou, Katrien

AU - Adam, Kai Manuel

AU - Akalin, Emin Halis

AU - Akova, Murat

AU - Arsenijevic, Valentina Arsic

AU - Aujayeb, Avinash

AU - Blennow, Ola

AU - Bretagne, Stéphane

AU - Danion, François

AU - Denis, Blandine

AU - de Jonge, Nick Alexander

AU - Desoubeaux, Guillaume

AU - Drgona, Lubos

AU - Erben, Nurettin

AU - Gori, Andrea

AU - García Rodríguez, Julio

AU - Garcia-Vidal, Carolina

AU - Giacobbe, Daniele Roberto

AU - Goodman, Anna L.

AU - Hamal, Petr

AU - Hammarström, Helena

AU - Toscano, Cristina

AU - Lanternier, Fanny

AU - Lass-Flörl, Cornelia

AU - Lockhart, Deborah E. A.

AU - Longval, Thomas

AU - Loughlin, Laura

AU - Matos, Tadeja

AU - Mikulska, Malgorzata

AU - Narayanan, Manjusha

AU - Martín-Pérez, Sonia

AU - Prattes, Juergen

AU - Rogers, Benedict

AU - Rahimli, Laman

AU - Ruiz, Maite

AU - Roilides, Emmanuel

AU - Samarkos, Michael

AU - Scharmann, Ulrike

AU - Sili, Uluhan

AU - Sipahi, Oguz Resat

AU - Sivakova, Alena

AU - Steinmann, Joerg

AU - Trauth, Janina

AU - Turhan, Ozge

AU - Van Praet, Jens

AU - Vena, Antonio

AU - White, P. Lewis

AU - Willinger, Birgit

AU - Tortorano, Anna Maria

AU - Arendrup, Maiken C.

AU - Koehler, Philipp

AU - Cornely, Oliver A.

AU - ECMM Candida III Study Group

N1 - Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023

Y1 - 2023

N2 - Background: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. Methods: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. Findings: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05–1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4–30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. Interpretation: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. Funding: Scynexis.

AB - Background: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes. Methods: In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines. Findings: 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1·08 [95% CI 1·04–1·11; p<0·0001] in patients with a central venous catheter and 1·09 [1·05–1·13; p<0·0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4–30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals. Interpretation: Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay. Funding: Scynexis.

U2 - 10.1016/S1473-3099(22)00872-6

DO - 10.1016/S1473-3099(22)00872-6

M3 - Journal article

C2 - 37254300

AN - SCOPUS:85149651043

VL - 23

SP - 751

EP - 761

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 6

ER -