Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study
Articolo
Data di Pubblicazione:
2023
Citazione:
Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study / M. Hoenigl, J. Salmanton-García, M. Egger, J. Gangneux, T. Bicanic, S. Arikan-Akdagli, A. Alastruey-Izquierdo, N. Klimko, A. Barac, V. Özenci, E.F.J. Meijer, N. Khanna, M. Bassetti, R. Rautemaa-Richardson, K. Lagrou, K. Adam, E.H. Akalin, M. Akova, V. Arsic Arsenijevic, A. Aujayeb, O. Blennow, S. Bretagne, F. Danion, B. Denis, N.A. de Jonge, G. Desoubeaux, L. Drgona, N. Erben, A. Gori, J. García Rodríguez, C. Garcia-Vidal, D.R. Giacobbe, A.L. Goodman, P. Hamal, H. Hammarström, C. Toscano, F. Lanternier, C. Lass-Flörl, D.E.A. Lockhart, T. Longval, L. Loughlin, T. Matos, M. Mikulska, M. Narayanan, S. Martín-Pérez, J. Prattes, B. Rogers, L. Rahimli, M. Ruiz, E. Roilides, M. Samarkos, U. Scharmann, U. Sili, O.R. Sipahi, A. Sivakova, J. Steinmann, J. Trauth, O. Turhan, J. Van Praet, A. Vena, P.L. White, B. Willinger, A.M. Tortorano, M.C. Arendrup, P. Koehler, O.A. Cornely, M. Tumbarello, A.F. Talento, A.C. Ruiz, Z. Racil, I. Stoma, M. Calbacho, E. Van Wijngaerden, J. Henriques, H. Jordan, V. Ferroni, O.K. Ozyurt, C. Milacek, R. Krause, C. Zurl, M. Backx, A. Li, R. Seufert, R. Tomazin, Y. Blankenheim, J. Dávila-Valls, P. García-Clemente, T. Freiberger, J. Buil, J.F. Meis, D. Akyol, H. Guegan, C. Logan. - In: THE LANCET INFECTIOUS DISEASES. - ISSN 1473-3099. - (2023), pp. 1-11. [Epub ahead of print] [10.1016/S1473-3099(22)00872-6]
Abstract:
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.
Tipologia IRIS:
01 - Articolo su periodico
Elenco autori:
M. Hoenigl, J. Salmanton-García, M. Egger, J. Gangneux, T. Bicanic, S. Arikan-Akdagli, A. Alastruey-Izquierdo, N. Klimko, A. Barac, V. Özenci, E.F.J. Meijer, N. Khanna, M. Bassetti, R. Rautemaa-Richardson, K. Lagrou, K. Adam, E.H. Akalin, M. Akova, V. Arsic Arsenijevic, A. Aujayeb, O. Blennow, S. Bretagne, F. Danion, B. Denis, N.A. de Jonge, G. Desoubeaux, L. Drgona, N. Erben, A. Gori, J. García Rodríguez, C. Garcia-Vidal, D.R. Giacobbe, A.L. Goodman, P. Hamal, H. Hammarström, C. Toscano, F. Lanternier, C. Lass-Flörl, D.E.A. Lockhart, T. Longval, L. Loughlin, T. Matos, M. Mikulska, M. Narayanan, S. Martín-Pérez, J. Prattes, B. Rogers, L. Rahimli, M. Ruiz, E. Roilides, M. Samarkos, U. Scharmann, U. Sili, O.R. Sipahi, A. Sivakova, J. Steinmann, J. Trauth, O. Turhan, J. Van Praet, A. Vena, P.L. White, B. Willinger, A.M. Tortorano, M.C. Arendrup, P. Koehler, O.A. Cornely, M. Tumbarello, A.F. Talento, A.C. Ruiz, Z. Racil, I. Stoma, M. Calbacho, E. Van Wijngaerden, J. Henriques, H. Jordan, V. Ferroni, O.K. Ozyurt, C. Milacek, R. Krause, C. Zurl, M. Backx, A. Li, R. Seufert, R. Tomazin, Y. Blankenheim, J. Dávila-Valls, P. García-Clemente, T. Freiberger, J. Buil, J.F. Meis, D. Akyol, H. Guegan, C. Logan
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