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

被引：77

作者：

Hoenigl, Martin ^{[1
,2
,3
]}

Salmanton-Garcia, Jon ^{[4
,6
,7
,9
,10
]}

Egger, Matthias ^{[1
,2
]}

Gangneux, Jean-Pierre ^{[11
]}

Bicanic, Tihana ^{[12
]}

Arikan-Akdagli, Sevtap ^{[13
]}

Alastruey-Izquierdo, Ana ^{[15
]}

Klimko, Nikolai ^{[16
]}

Barac, Aleksandra ^{[17
]}

Ozenci, Volkan ^{[19
,20
]}

Meijer, Eelco F. J. ^{[22
,23
,24
]}

Khanna, Nina ^{[25
]}

Bassetti, Matteo ^{[26
,27
]}

Rautemaa-Richardson, Riina ^{[28
,29
,30
]}

Lagrou, Katrien ^{[31
,32
,33
]}

Adam, Kai -Manuel ^{[25
]}

Akalin, Emin Halis ^{[34
]}

Akova, Murat ^{[14
]}

Arsenijevic, Valentina Arsic ^{[18
,35
]}

Aujayeb, Avinash ^{[36
]}

Blennow, Ola ^{[21
]}

Bretagne, Stephane ^{[37
]}

Danion, Francois ^{[40
]}

Denis, Blandine ^{[38
]}

de Jonge, Nick Alexander ^{[41
]}

Desoubeaux, Guillaume ^{[42
]}

Drgona, Lubos ^{[43
,44
]}

Erben, Nurettin ^{[45
]}

Gori, Andrea ^{[46
,47
,48
]}

Rodriguez, Julio Garcia ^{[49
]}

Garcia-Vidal, Carolina ^{[50
]}

Giacobbe, Daniele Roberto ^{[26
,27
]}

Goodman, Anna L. ^{[51
,52
]}

Hamal, Petr ^{[53
]}

Hammarstrom, Helena ^{[54
]}

Toscano, Cristina ^{[55
]}

Lanternier, Fanny ^{[39
]}

Lass-Floerl, Cornelia ^{[56
]}

Lockhart, Deborah E. A. ^{[57
,58
]}

Longval, Thomas ^{[59
]}

Loughlin, Laura ^{[60
]}

Matos, Tadeja ^{[61
]}

Mikulska, Malgorzata ^{[26
,27
]}

Narayanan, Manjusha ^{[62
]}

Martin-Perez, Sonia ^{[63
]}

Prattes, Juergen ^{[1
,2
,3
,6
,7
]}

Rogers, Benedict ^{[64
]}

Rahimli, Laman ^{[4
,6
,7
,9
,10
]}

Ruiz, Maite ^{[65
,66
]}

Roilides, Emmanuel ^{[67
]}

机构：

[1] Med Univ Graz, Dept Internal Med, Div Infect Dis, Graz, Austria

[2] Med Univ Graz, Translat Med Mycol Res Unit, European Confederat Med Mycol Excellence Ctr Med, Graz, Austria

[3] BioTechMed, Graz, Austria

[4] Univ Cologne, Cologne Excellence Cluster Cellular Stress Respon, Cologne, Germany

[5] Univ Cologne, Clin Trials Ctr Cologne ZKS Koln, Cologne, Germany

[6] Univ Cologne, Dept Internal Med 1, Ctr Integrated Oncol Aachen Bonn Cologne Duesseld, Cologne, Germany

[7] Univ Cologne, European Confederat Med Mycol Excellence Ctr Med, Cologne, Germany

[8] Univ Cologne, Ctr Mol Med Cologne, Cologne, Germany

[9] Univ Cologne, Fac Med, Cologne, Germany

[10] Univ Cologne, Univ Hosp Cologne, Cologne, Germany

[11] Univ Rennes, CHU Rennes, INSERM, EHESP,Irset,UMR S 1085, Rennes, France

[12] St Georges Univ London, Inst Infect & Immun, London, England

[13] Hacettepe Univ, Sch Med, Dept Med Microbiol, Ankara, Turkiye

[14] Hacettepe Univ, Sch Med, Dept Infect Dis & Clin Microbiol, Ankara, Turkiye

[15] Inst Salud Carlos III, Mycol Reference Lab, Natl Ctr Microbiol, Madrid, Spain

[16] North Western State Med Univ, Dept Clin Mycol Allergy & Immunol, St Petersburg, Russia

[17] Univ Belgrade, Univ Clin Ctr Serbia, Clin Infect & Trop Dis, Fac Med, Belgrade, Serbia

[18] Univ Belgrade, Med Mycol Reference Lab, Inst Microbiol & Immunol, Fac Med, Belgrade, Serbia

[19] Karolinska Inst, Div Clin Microbiol, Dept Lab Med, Stockholm, Sweden

[20] Karolinska Univ Hosp, Dept Clin Microbiol, Stockholm, Sweden

[21] Karolinska Univ Hosp, Dept Infect Dis, Stockholm, Sweden

[22] Canisius Wilhelmina Hosp CWZ, Dept Med Microbiol & Infect Dis, Nijmegen, Netherlands

[23] Radboudumc CWZ, Ctr Expertise Mycol, Nijmegen, Netherlands

[24] Radboud Univ Nijmegen, Dept Med Microbiol, Med Ctr, Nijmegen, Netherlands

[25] Univ Hosp Basel, Div Infect Dis & Hosp Epidemiol, Basel, Switzerland

[26] Univ Genoa, Dept Hlth Sci DISSAL, Genoa, Italy

[27] IRCCS Osped Policlin San Martino, Infect Dis Unit, Genoa, Italy

[28] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Mycol Reference Ctr Manchester, Manchester, Lancs, England

[29] Manchester Univ NHS Fdn Trust, Wythenshawe Hosp, Dept Infect Dis, Manchester, Lancs, England

[30] Univ Manchester, Div Evolut Infect & Genom, Fac Biol Med & Hlth, Manchester, Lancs, England

[31] Katholieke Univ Leuven, Lab Clin Microbiol, Dept Microbiol Immunol & Transplantat, Leuven, Belgium

[32] UZ Leuven, Dept Lab Med, Leuven, Belgium

[33] UZ Leuven, Natl Reference Ctr Mycosis, Leuven, Belgium

[34] Bursa Uludag Univ, Dept Infect Dis & Clin Microbiol, Fac Med, Bursa, Turkiye

[35] Inst Publ Hlth Vojvodina, Ctr Microbiol, Novi Sad, Serbia

[36] Northumbria Healthcare NHS Fdn Trust, North Shields, England

[37] St Louis Univ Hosp, AP HP, Lab Parasitol & Mycol, Paris, France

[38] Hop St Louis Fernand Widal, AP HP, Dept Infect Dis, Paris, France

[39] Paris Cite Univ, Necker Hosp, Dept Infect Dis, Paris, France

[40] Univ Strasbourg, Dept Infect Dis, Ctr Hosp Univ Strasbourg, Strasbourg, France

[41] Univ Amsterdam, Dept Hematol, Med Ctr, Amsterdam, Netherlands

[42] Ctr Hosp Reg Univ Tours, Dept Parasitol Mycol Trop Med, Tours, France

[43] Comenius Univ, Dept Oncohematol, Bratislava, Slovakia

[44] Natl Canc Inst, Bratislava, Slovakia

[45] Eskisehir Osmangazi Univ, Fac Med, Dept Infect Dis & Clin Microbiol, Eskisehir, Turkiye

[46] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Dept Internal Med, Infect Dis Unit, Milan, Italy

[47] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

[48] Univ Milan, Ctr Multidisciplinary Res Hlth Sci MACH, Milan, Italy

[49] La Paz Univ Hosp, Dept Microbiol, Madrid, Spain

[50] Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain

来源：

LANCET INFECTIOUS DISEASES | 2023年 / 23卷 / 06期

关键词：

ESCMID-ASTERISK GUIDELINE; MANAGEMENT; EPIDEMIOLOGY; DIAGNOSIS;

D O I：

10.1016/S1473-3099(22)00872-6

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

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 & BULL;08 [95% CI 1 & BULL;04-1 & BULL;11; p<0 & BULL;0001] in patients with a central venous catheter and 1 & BULL;09 [1 & BULL;05-1 & BULL;13; p<0 & BULL;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.Copyright & COPY; 2023 Elsevier Ltd. All rights reserved.

引用

页码：751 / 761

页数：11

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