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Article Dans Une Revue The Lancet Infectious Diseases Année : 2023

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

Martin Hoenigl (1) , Jon Salmanton-García (2) , Matthias Egger (1) , Jean-Pierre Gangneux (3, 4) , Tihana Bicanic , Sevtap Arikan-Akdagli , Ana Alastruey-Izquierdo , Nikolai Klimko , Aleksandra Barac , Volkan Özenci , Eelco Meijer , Nina Khanna , Matteo Bassetti , Riina Rautemaa-Richardson , Katrien Lagrou , Kai-Manuel Adam , Emin Halis Akalin , Murat Akova , Valentina Arsic Arsenijevic , Avinash Aujayeb , Ola Blennow , Stéphane Bretagne , François Danion , Blandine Denis , Nick Alexander de Jonge , Guillaume Desoubeaux , Lubos Drgona , Nurettin Erben , Andrea Gori , Julio García Rodríguez , Carolina Garcia-Vidal , Daniele Roberto Giacobbe , Anna Goodman , Petr Hamal , Helena Hammarström , Cristina Toscano , Fanny Lanternier , Cornelia Lass-Flörl , Deborah Lockhart , Thomas Longval , Laura Loughlin , Tadeja Matos , Malgorzata Mikulska , Manjusha Narayanan , Sonia Martín-Pérez , Juergen Prattes , Benedict Rogers , Laman Rahimli , Maite Ruiz , Emmanuel Roilides , Michael Samarkos , Ulrike Scharmann , Uluhan Sili , Oguz Resat Sipahi , Alena Sivakova , Joerg Steinmann , Janina Trauth , Ozge Turhan , Jens van Praet , Antonio Vena , P Lewis White , Birgit Willinger , Anna Maria Tortorano , Maiken Arendrup , Philipp Koehler (2) , Oliver Cornely (2) , Mario Tumbarello , Alida Fe Talento , Alba Ruiz , Zdenek Racil , Igor Stoma , Maria Calbacho , Eric van Wijngaerden , Júlia Henriques , Harriett Jordan , Valentina Ferroni , Ozlem Koyuncu Ozyurt , Christopher Milacek , Robert Krause , Christoph Zurl , Matthijs Backx , Ang Li , Raphael Seufert , Rok Tomazin , Yael Blankenheim , Julio Dávila-Valls , Paloma García-Clemente , Tomas Freiberger , Jochem Buil , Jacques Meis , Deniz Akyol , Hélène Guegan , Clare Logan
Martin Hoenigl
Jon Salmanton-García
Matthias Egger
Tihana Bicanic
Sevtap Arikan-Akdagli
Ana Alastruey-Izquierdo
Nikolai Klimko
Aleksandra Barac
  • Fonction : Auteur
Volkan Özenci
Eelco Meijer
Nina Khanna
Matteo Bassetti
Riina Rautemaa-Richardson
Katrien Lagrou
Kai-Manuel Adam
Emin Halis Akalin
Murat Akova
Valentina Arsic Arsenijevic
Avinash Aujayeb
Ola Blennow
Stéphane Bretagne
François Danion
Blandine Denis
  • Fonction : Auteur
Nick Alexander de Jonge
Guillaume Desoubeaux
Lubos Drgona
Nurettin Erben
Andrea Gori
Julio García Rodríguez
  • Fonction : Auteur
Carolina Garcia-Vidal
  • Fonction : Auteur
Daniele Roberto Giacobbe
Anna Goodman
Petr Hamal
Helena Hammarström
Cristina Toscano
Fanny Lanternier
  • Fonction : Auteur
Cornelia Lass-Flörl
Deborah Lockhart
Thomas Longval
Laura Loughlin
  • Fonction : Auteur
Tadeja Matos
Malgorzata Mikulska
Manjusha Narayanan
  • Fonction : Auteur
Sonia Martín-Pérez
Juergen Prattes
Benedict Rogers
Laman Rahimli
Maite Ruiz
  • Fonction : Auteur
Emmanuel Roilides
Michael Samarkos
Ulrike Scharmann
Uluhan Sili
Oguz Resat Sipahi
  • Fonction : Auteur
Alena Sivakova
Joerg Steinmann
Janina Trauth
  • Fonction : Auteur
Ozge Turhan
Jens van Praet
Antonio Vena
P Lewis White
Birgit Willinger
Anna Maria Tortorano
Maiken Arendrup
Philipp Koehler
Oliver Cornely
Mario Tumbarello
  • Fonction : Auteur
Alida Fe Talento
Alba Ruiz
  • Fonction : Auteur
Zdenek Racil
  • Fonction : Auteur
Igor Stoma
  • Fonction : Auteur
Maria Calbacho
  • Fonction : Auteur
Eric van Wijngaerden
  • Fonction : Auteur
Júlia Henriques
  • Fonction : Auteur
Harriett Jordan
  • Fonction : Auteur
Valentina Ferroni
  • Fonction : Auteur
Ozlem Koyuncu Ozyurt
  • Fonction : Auteur
Christopher Milacek
Robert Krause
  • Fonction : Auteur
Christoph Zurl
  • Fonction : Auteur
Matthijs Backx
  • Fonction : Auteur
Ang Li
  • Fonction : Auteur
Raphael Seufert
  • Fonction : Auteur
Rok Tomazin
  • Fonction : Auteur
Yael Blankenheim
  • Fonction : Auteur
Julio Dávila-Valls
Paloma García-Clemente
  • Fonction : Auteur
Tomas Freiberger
Jochem Buil
  • Fonction : Auteur
Jacques Meis
  • Fonction : Auteur
Deniz Akyol
  • Fonction : Auteur
Hélène Guegan
  • Fonction : Auteur
Clare Logan
  • Fonction : Auteur

Résumé

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.
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Hoenigl et al - 2023 - Guideline adherence predicts Survival of Candidemia in Europe _Guideline adherence Outcomes of Candidemia v24 clean rev.pdf (861.79 Ko) Télécharger le fichier
Online Supplement Candida III rev v2.pdf (709.73 Ko) Télécharger le fichier
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hal-04164281 , version 1 (21-07-2023)

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Paternité - Pas d'utilisation commerciale

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Martin Hoenigl, Jon Salmanton-García, Matthias Egger, Jean-Pierre Gangneux, Tihana Bicanic, 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, 23 (6), pp.751-761. ⟨10.1016/S1473-3099(22)00872-6⟩. ⟨hal-04164281⟩
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