Cargando…

753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study

BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of culture proven candidemia across Europe in order to assess how adherence to guideline recommendations correlate with outcomes. METHODS: Each participating hospit...

Descripción completa

Detalles Bibliográficos
Autores principales: Hoenigl, Martin, Egger, Matthias, Salmanton-Garcia, Jon, Koehler, Philipp, Gangneux, Jean-Pierre, Arendrup, Maiken C, Bicanic, Tihana, Arikan-Akdagli, Sevtap, Cornely, Oliver A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751899/
http://dx.doi.org/10.1093/ofid/ofac492.038
_version_ 1784850585650987008
author Hoenigl, Martin
Egger, Matthias
Salmanton-Garcia, Jon
Koehler, Philipp
Gangneux, Jean-Pierre
Arendrup, Maiken C
Bicanic, Tihana
Arikan-Akdagli, Sevtap
Cornely, Oliver A
author_facet Hoenigl, Martin
Egger, Matthias
Salmanton-Garcia, Jon
Koehler, Philipp
Gangneux, Jean-Pierre
Arendrup, Maiken C
Bicanic, Tihana
Arikan-Akdagli, Sevtap
Cornely, Oliver A
author_sort Hoenigl, Martin
collection PubMed
description BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of culture proven candidemia across Europe in order to assess how adherence to guideline recommendations correlate with outcomes. METHODS: Each participating hospital (number of eligible hospitals per country determined by population size) included the first ∼10 culture proven IC cases after 01-Jul-18 and entered data into the ECMM Candida III database on the FungiScope™ platform. EQUAL Candida Scores (10.1111/myc.12746) reflecting adherence to recommendations of IDSA and ESCMID Guidelines were assessed. RESULTS: A total of 632 Candidemia cases were included from 64 institutions in 20 European countries. Patients characteristics are displayed in Table 1. Overall mortality was 45% (286/632), and hospital stay was prolonged (median 2 days) for completion of parenteral therapy only in 16% (100/621) of patients. EQUAL Candida Score was evaluable for 589 cases with candidemia (Figure 1). Candida scores correlated significantly with duration of hospitalization (r= 0.442; p< 0.001) and - after exclusion of patients hospitalized < 7 days (n=119) - were significantly higher in patients who survived versus those who died (p< 0.001). Duration of hospitalization was in median 16 days after diagnosis of candidemia. Initial echinocandin treatment was associated a.) with lower overall mortality (42%, 148/353) versus those without initial echinocandin therapy (53%, 126/236; p=0.007), and b.) with longer duration of hospitalization among survivors (median 24 days, IQR 15–40 days vs. median 16 days, IQR 7–33 days; p< 0.001). In those where candidemia was treated for at least 14 days, 78% (239/306) survived, compared to 66% (67/102) in those treated for less than 14 days, but who survived beyond day 14 after diagnosis. [Figure: see text] [Figure: see text] CONCLUSION: Initial echinocandin treatment was associated with increased overall survival, but also longer duration of hospitalization (hospitalization was prolonged only for completing treatment in 16%). Overall mortality of IC was 45%. EQUAL Candida scores were significantly higher on those who survived, indicating that adherence to clinical guidelines may increase survival. DISCLOSURES: Martin Hoenigl, n/a, Astellas: Grant/Research Support|Gilead: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Scynexis: Grant/Research Support Maiken C. Arendrup, DMSci, PhD, MD, Chiesi, Gilead: Honoraria|F2G, Cidara, Scynexis: Grant/Research Support Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Actelion: Board Member|Al-Jazeera Pharmaceuticals: Honoraria|Allecra Therapeutics: Board Member|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Honoraria|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|Biocon: Advisor/Consultant|Biosys: Advisor/Consultant|BMBF: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Expert Testimony|Cidara: Grant/Research Support|CoRe Consulting: Stocks/Bonds|Da Volterra: Advisor/Consultant|DLR: Grant/Research Support|DZIF: Grant/Research Support|Entasis: Board Member|EU Directorate-General for Resarch and Innovation: Grant/Research Support|F2G: Grant/Research Support|German Patent and Trade Mark Office: German patent (DE 10 2021 113 007.7)|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Grupo Biotoscana/United Medical/Knight: Honoraria|Hikma: Honoraria|IQVIA: Board Member|Janssen: Board Member|Matinas: Advisor/Consultant|Matinas: Grant/Research Support|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedScape: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Merck/MSD: Grant/Research Support|Merck/MSD: Honoraria|Molecular Partners: Advisor/Consultant|MSG-ERC: Advisor/Consultant|Mundipharma: Grant/Research Support|Mylan: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Paratek: Board Member|Pardes: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Projektträger Jülich: Grant/Research Support|PSI: Advisor/Consultant|PSI: Board Member|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seres: Advisor/Consultant|Shionogi: Board Member|Wiley (Blackwell): Editor-in-Chief, Mycoses.
format Online
Article
Text
id pubmed-9751899
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-97518992022-12-16 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study Hoenigl, Martin Egger, Matthias Salmanton-Garcia, Jon Koehler, Philipp Gangneux, Jean-Pierre Arendrup, Maiken C Bicanic, Tihana Arikan-Akdagli, Sevtap Cornely, Oliver A Open Forum Infect Dis Abstracts BACKGROUND: The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of culture proven candidemia across Europe in order to assess how adherence to guideline recommendations correlate with outcomes. METHODS: Each participating hospital (number of eligible hospitals per country determined by population size) included the first ∼10 culture proven IC cases after 01-Jul-18 and entered data into the ECMM Candida III database on the FungiScope™ platform. EQUAL Candida Scores (10.1111/myc.12746) reflecting adherence to recommendations of IDSA and ESCMID Guidelines were assessed. RESULTS: A total of 632 Candidemia cases were included from 64 institutions in 20 European countries. Patients characteristics are displayed in Table 1. Overall mortality was 45% (286/632), and hospital stay was prolonged (median 2 days) for completion of parenteral therapy only in 16% (100/621) of patients. EQUAL Candida Score was evaluable for 589 cases with candidemia (Figure 1). Candida scores correlated significantly with duration of hospitalization (r= 0.442; p< 0.001) and - after exclusion of patients hospitalized < 7 days (n=119) - were significantly higher in patients who survived versus those who died (p< 0.001). Duration of hospitalization was in median 16 days after diagnosis of candidemia. Initial echinocandin treatment was associated a.) with lower overall mortality (42%, 148/353) versus those without initial echinocandin therapy (53%, 126/236; p=0.007), and b.) with longer duration of hospitalization among survivors (median 24 days, IQR 15–40 days vs. median 16 days, IQR 7–33 days; p< 0.001). In those where candidemia was treated for at least 14 days, 78% (239/306) survived, compared to 66% (67/102) in those treated for less than 14 days, but who survived beyond day 14 after diagnosis. [Figure: see text] [Figure: see text] CONCLUSION: Initial echinocandin treatment was associated with increased overall survival, but also longer duration of hospitalization (hospitalization was prolonged only for completing treatment in 16%). Overall mortality of IC was 45%. EQUAL Candida scores were significantly higher on those who survived, indicating that adherence to clinical guidelines may increase survival. DISCLOSURES: Martin Hoenigl, n/a, Astellas: Grant/Research Support|Gilead: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Scynexis: Grant/Research Support Maiken C. Arendrup, DMSci, PhD, MD, Chiesi, Gilead: Honoraria|F2G, Cidara, Scynexis: Grant/Research Support Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Actelion: Board Member|Al-Jazeera Pharmaceuticals: Honoraria|Allecra Therapeutics: Board Member|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Honoraria|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|Biocon: Advisor/Consultant|Biosys: Advisor/Consultant|BMBF: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Expert Testimony|Cidara: Grant/Research Support|CoRe Consulting: Stocks/Bonds|Da Volterra: Advisor/Consultant|DLR: Grant/Research Support|DZIF: Grant/Research Support|Entasis: Board Member|EU Directorate-General for Resarch and Innovation: Grant/Research Support|F2G: Grant/Research Support|German Patent and Trade Mark Office: German patent (DE 10 2021 113 007.7)|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Grupo Biotoscana/United Medical/Knight: Honoraria|Hikma: Honoraria|IQVIA: Board Member|Janssen: Board Member|Matinas: Advisor/Consultant|Matinas: Grant/Research Support|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedScape: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Merck/MSD: Grant/Research Support|Merck/MSD: Honoraria|Molecular Partners: Advisor/Consultant|MSG-ERC: Advisor/Consultant|Mundipharma: Grant/Research Support|Mylan: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Paratek: Board Member|Pardes: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Projektträger Jülich: Grant/Research Support|PSI: Advisor/Consultant|PSI: Board Member|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seres: Advisor/Consultant|Shionogi: Board Member|Wiley (Blackwell): Editor-in-Chief, Mycoses. Oxford University Press 2022-12-15 /pmc/articles/PMC9751899/ http://dx.doi.org/10.1093/ofid/ofac492.038 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Abstracts
Hoenigl, Martin
Egger, Matthias
Salmanton-Garcia, Jon
Koehler, Philipp
Gangneux, Jean-Pierre
Arendrup, Maiken C
Bicanic, Tihana
Arikan-Akdagli, Sevtap
Cornely, Oliver A
753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title_full 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title_fullStr 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title_full_unstemmed 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title_short 753. Guideline Adherence Predicts Outcomes of Candidemia in Europe: Results from the ECMM Candida III Multinational European study
title_sort 753. guideline adherence predicts outcomes of candidemia in europe: results from the ecmm candida iii multinational european study
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9751899/
http://dx.doi.org/10.1093/ofid/ofac492.038
work_keys_str_mv AT hoeniglmartin 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT eggermatthias 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT salmantongarciajon 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT koehlerphilipp 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT gangneuxjeanpierre 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT arendrupmaikenc 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT bicanictihana 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT arikanakdaglisevtap 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT cornelyolivera 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy
AT 753guidelineadherencepredictsoutcomesofcandidemiaineuroperesultsfromtheecmmcandidaiiimultinationaleuropeanstudy