The Lancet Infectious Diseases

, volume 23 , issue 6 , pages 751-761

Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study

M. Hoenigl ^{1, 2}

J. Salmanton-García ^{3, 4, 5}

Matthias Egger ²

Jean-Pierre Gangneux ⁶

Tihana Bicanic ⁷

Sevtap Arikan-Akdagli ⁸

Ana Alastruey-Izquierdo ⁹

N. Klimko ¹⁰

Aleksandra Barac ¹¹

Volkan Özenci ^{12, 13}

Eelco F.J. Meijer ^{14, 15, 16}

N Khanna ¹⁷

M. Bassetti ^{18, 19}

Riina Rautemaa-Richardson ^{20, 21}

Katrien Lagrou ²²

Kai-Manuel Adam ¹⁷

Halis Akalin ²³

Murat Akova ²⁴

Valentina Arsić-Arsenijević ^{25, 26}

Avinash Aujayeb ²⁷

Ola Blennow ²⁸

Stéphane Bretagne ²⁹

François Danion ³⁰

Blandine Denis ³¹

Nick de Jonge ³²

Guillaume Desoubeaux ³³

Lubos Drgona ³⁴

Nurettin Erben ³⁵

Andrea Gori ^{36, 37}

Julio García Rodríguez ³⁸

Carolina Garcia-Vidal ³⁹

Daniele R. Giacobbe ^{18, 19}

Anna L Goodman ^{40, 41}

Petr Hamal ⁴²

Helena Hammarström ⁴³

Cristina Toscano ⁴⁴

Fanny Lanternier ⁴⁵

Cornelia Lass-Flörl ⁴⁶

Deborah Frank Lockhart ^{47, 48}

Thomas Longval ⁴⁹

Laura Loughlin ⁵⁰

Tadeja Matos ⁵¹

Małgorzata Mikulska ^{18, 19}

Manjusha Narayanan ⁵²

Sonia Martin Perez ⁵³

Juergen Prattes ^{1, 2, 4}

Benedict Rogers ⁵⁴

Laman Rahimli ^{3, 4, 5}

Maite Ruiz ^{55, 56}

EMMANUEL ROILIDES ⁵⁷

M. Samarkos ⁵⁸

Ulrike Scharmann ⁵⁹

Uluhan Sili ⁶⁰

Oğuz Reşat Sipahi ⁶¹

Alena Siváková ⁶²

J. Steinmann ^{59, 63}

Janina Trauth ⁶⁴

Özge Turhan ⁶⁵

Jens T Van Praet ⁶⁶

Antonio Vena ^{18, 19}

P. Lewis White ^{67, 68}

Birgit Willinger ⁶⁹

A-M. TORTORANO ⁷⁰

Maiken Arendrup ^{71, 72, 73}

Philipp Koehler ^{3, 4, 5, 74}

Oliver A. Cornely ^{3, 5, 74, 75}

Alba C Ruiz ^{55, 56}

Maria Calbacho ⁷⁰

Valentina Ferroni ^{25, 26}

Robert Krause ^{18, 19}

Ang Li ^{3, 5, 74, 75}

J. Dávila ³⁸

Hide authors affiliations Show authors affiliations: 75 affiliations

BioTechMed, Graz, Austria |

Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria |

Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany |

⁴

Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, and European Confederation of Medical Mycology Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany |

⁵

Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany |

⁶

Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes, France

French Institute of Health and Medical Research

Centre Hospitalier Universitaire de Rennes

Research Institute for Environmental and Occupation Health

⁷

Institute of Infection and Immunity, St George's University of London, London, UK |

⁸

Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Türkiye |

⁹

Mycology Reference Laboratory, National Centre for Microbiology, Instituto De Salud Carlos III, Madrid, Spain |

¹⁰

Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, St Petersburg, Russia |

¹¹

Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia

University of Belgrade

Clinical Center of Serbia

¹²

Department of Clinical microbiology, Karolinska University Hospital, Stockholm, Sweden |

¹³

Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden |

¹⁴

Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands

Radboud University Nijmegen Medical Centre

Canisius-Wilhelmina Ziekenhuis

¹⁵

Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital (CWZ), Nijmegen, Netherlands |

¹⁶

Department of Medical Microbiology, Radboud university medical center, Nijmegen, Netherlands |

¹⁷

Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Basel, Basel, Switzerland |

¹⁸

Department of Health Sciences (Dissal), University of Genoa, Genoa, Italy |

¹⁹

Infectious Diseases Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

Istituti di Ricovero e Cura a Carattere Scientifico

Hospital San Martino

²⁰

Division of Evolution, Infection and Genomics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK |

²¹

Mycology Reference Centre Manchester and Department of Infectious Diseases, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK |

²²

Department of Laboratory Medicine and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium |

²³

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Bursa Uludağ University, Bursa, Türkiye |

²⁴

Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Medical School, Ankara, Türkiye |

²⁵

Centre for Microbiology, Institute of Public Health of Vojvodina, Novi Sad, Serbia |

²⁶

Medical Mycology Reference Laboratory, Institute of Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia |

²⁷

Northumbria Healthcare NHS Foundation Trust, North Shields, UK |

²⁸

Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden |

²⁹

Laboratory of Parasitology and Mycology, Saint Louis University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France |

³⁰

Department of Infectious Diseases, Centre Hospitalier Universitaire de Strasbourg, Université de Strasbourg, Strasbourg, France |

³¹

Department of Infectious Diseases, Hôpital Saint-Louis, Fernand Widal, Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France |

³²

Department of Hematology, Amsterdam University Medical Centers, Amsterdam, Netherlands |

³³

Department of Parasitology-Mycology-Tropical Medicine, Centre Hospitalier Régional Universitaire de Tours, Tours, France |

³⁴

Department of Oncohematology, Comenius University and National Cancer Institute, Bratislava, Slovakia

Comenius University Bratislava

National Cancer Institute (Slovakia)

³⁵

Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Türkiye |

³⁶

Department of Internal Medicine, Infectious Diseases Unit, FondazioneIRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy |

³⁷

Department of Pathophysiology and Transplantation and Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy |

³⁸

Microbiology Department, La Paz University Hospital, Madrid, Spain |

³⁹

Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain |

⁴⁰

Department of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK |

⁴¹

Medical Research Council Clinical Trials Unit, University College London, London, UK |

⁴²

Department of Microbiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic |

⁴³

Department of infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden |

⁴⁴

Laboratory of Clinical Microbiology and Molecular Biology, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal |

⁴⁵

Paris Cité Université, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France

Paris Cité University

Necker–Enfants Malades Hospital

⁴⁶

Institute of Hygiene and Medical Microbiology, European Confederation of Medical Mycology Excellence Center for Medical Mycology, Innsbruck Medical University, Innsbruck, Austria |

⁴⁷

Department of Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK |

⁴⁸

Institute of Medical Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK |

⁴⁹

Centre Hospitalier de Versailles, Hématologie, Le Chesnay, France |

⁵⁰

Belfast Health and Social Care Trust, Belfast, UK |

⁵¹

Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia |

⁵²

Newcastle upon Tyne Hospitals NHS foundation trust, Newcastle upon Tyne, UK |

⁵³

Hospital Nuestra Señora de Sonsoles, Ávila, Spain |

⁵⁴

Department of Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, UK |

⁵⁵

Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain |

⁵⁶

Unit of Infectious Diseases and Microbiology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Seville, Spain

Universidad de Sevilla

Institute of Biomedicine of Seville

Virgen del Rocío University Hospital

⁵⁷

Infectious Diseases Department, Hippokration General Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece |

⁵⁸

First Department of Medicine, Laikon General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece |

⁵⁹

Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany |

⁶⁰

Department of Infectious Diseases and Clinical Microbiology, School of Medicine, Marmara University, Istanbul, Türkiye |

⁶¹

Department of Infectious Diseases and Clinical Microbiology, Ege University Medical School, Izmir, Türkiye |

⁶²

Department of Microbiology, St Anne's Faculty Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic |

⁶³

Institute for Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany |

⁶⁴

Section of Infectious Diseases, Department of Medicine II, Justus-Liebig-University Giessen, Giessen, Germany |

⁶⁵

Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Türkiye |

⁶⁶

Division of Nephrology and Infectious Diseases, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium |

⁶⁷

Centre for Trials Research and Division of Infection and Immunity, Cardiff University, Cardiff, UK |

⁶⁸

Microbiology Division, Public Health Wales, Cardiff, UK |

⁶⁹

Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria |

⁷⁰

Department of Public Health, Microbiology, and Virology, Università degli Studi di Milano, Milan, Italy |

⁷¹

Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark |

⁷²

Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark |

⁷³

Unit of Mycology, Statens Serum Institut, Copenhagen, Denmark |

⁷⁴

German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany |

⁷⁵

Centre for Molecular Medicine Cologne, University of Cologne, Cologne, Germany |

Publication type: Journal Article

Publication date: 2023-06-01

Elsevier

The Lancet Infectious Diseases

scimago Q1

wos Q1

SJR: 5.446

CiteScore: 42.6

Impact factor: 31.0

ISSN: 14733099, 14744457

DOI: 10.1016/s1473-3099(22)00872-6

Copy DOI

PubMed ID: 37254300

Infectious Diseases

Abstract

Summary

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.

Found

1 citation

Wake Rachel

63 publications, 7 452 citations, 5 reviews

h-index: 33

St George's, University of London

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Hoenigl M. et al. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study // The Lancet Infectious Diseases. 2023. Vol. 23. No. 6. pp. 751-761.

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@article{2023_Hoenigl,

author = {M. Hoenigl and J. Salmanton-García and Matthias Egger and Jean-Pierre Gangneux and Tihana Bicanic and Sevtap Arikan-Akdagli and Ana Alastruey-Izquierdo and N. Klimko and Aleksandra Barac and Volkan Özenci and Eelco F.J. Meijer and N Khanna and M. Bassetti and Riina Rautemaa-Richardson and Katrien Lagrou and Kai-Manuel Adam and Halis Akalin and Murat Akova and Valentina Arsić-Arsenijević and Avinash Aujayeb and Ola Blennow and Stéphane Bretagne and François Danion and Blandine Denis and Nick de Jonge and Guillaume Desoubeaux and Lubos Drgona and Nurettin Erben and Andrea Gori and Julio García Rodríguez and Carolina Garcia-Vidal and Daniele R. Giacobbe and Anna L Goodman and Petr Hamal and Helena Hammarström and Cristina Toscano and Fanny Lanternier and Cornelia Lass-Flörl and Deborah Frank Lockhart and Thomas Longval and Laura Loughlin and Tadeja Matos and Małgorzata Mikulska and Manjusha Narayanan and Sonia Martin Perez and Juergen Prattes and Benedict Rogers and Laman Rahimli and Maite Ruiz and EMMANUEL ROILIDES and others},

title = {Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study},

journal = {The Lancet Infectious Diseases},

year = {2023},

volume = {23},

publisher = {Elsevier},

month = {jun},

url = {https://doi.org/10.1016/s1473-3099(22)00872-6},

number = {6},

pages = {751--761},

doi = {10.1016/s1473-3099(22)00872-6}

}

MLA

Cite this

MLA Copy

Hoenigl, M., et al. “Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study.” The Lancet Infectious Diseases, vol. 23, no. 6, Jun. 2023, pp. 751-761. https://doi.org/10.1016/s1473-3099(22)00872-6.

Publisher

Elsevier

Journal

The Lancet Infectious Diseases

scimago Q1

wos Q1

SJR

5.446

CiteScore

42.6

Impact factor

31.0

ISSN

14733099 (Print)

14744457 (Electronic)

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