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Lookup NU author(s): Dr Manjusha Narayanan
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2024 The Author(s)Introduction: Despite antifungal advancements, candidaemia still has a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes of candidaemia for better understanding and management of these infections. Methods: In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with blood culture-proven candidemia. Collected data included patient demographics, risk factors, hospital stay duration (follow-up of 90 days), diagnostic procedures, causative Candida spp., management details, and outcome. Controls were included in a 1:1 fashion from the same hospitals. The matching process ensured similarity in age (10-year range), primary underlying disease, hospitalization in intensive care versus non-ICU ward, and major surgery within 2 weeks before candidemia between cases and controls. Overall and attributable mortality were described, and a survival probability for cases and controls was performed. Results: One hundred seventy-one pairs consisting of patients with candidemia and matched controls from 28 institutions were included. In those with candidemia, overall mortality was 40.4%. Attributable mortality was 18.1% overall but differed between causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata/Nakaseomyces glabratus, 7.7% for Candida parapsilosis and 63.6% for Candida tropicalis). Regarding risk factors, the presence of a central venous catheter, total parenteral nutrition and acute or chronic renal disease were significantly more common in cases versus controls. Duration of hospitalization, and especially that of ICU stay, was significantly longer in candidemia cases (20 (IQR 10–33) vs 15 days (IQR 7–28); p = 0.004). Conclusions: Although overall and attributable mortality in this subgroup analysis of matched case/control pairs remains high, the attributable mortality appears to have decreased in comparison to historical cohorts. This decrease may be driven by improved prognosis of Candida albicans and Candida parapsilosis candidemia; whereas candidemia due to other Candida spp. exhibits a much higher attributable mortality.
Author(s): Salmanton-Garcia J, Cornely OA, Stemler J, Barac A, Steinmann J, Sivakova A, Akalin EH, Arikan-Akdagli S, Loughlin L, Toscano C, Narayanan M, Rogers B, Willinger B, Akyol D, Roilides E, Lagrou K, Mikulska M, Denis B, Ponscarme D, Scharmann U, Azap A, Lockhart D, Bicanic T, Kron F, Erben N, Rautemaa-Richardson R, Goodman AL, Garcia-Vidal C, Lass-Florl C, Gangneux J-P, Taramasso L, Ruiz M, Schick Y, Van Wijngaerden E, Milacek C, Giacobbe DR, Logan C, Rooney E, Gori A, Akova M, Bassetti M, Hoenigl M, Koehler P
Publication type: Article
Publication status: Published
Journal: Journal of Infection
Year: 2024
Volume: 89
Issue: 3
Online publication date: 16/07/2024
Acceptance date: 06/07/2024
Date deposited: 06/08/2024
ISSN (print): 0163-4453
ISSN (electronic): 1532-2742
Publisher: W.B. Saunders Ltd
URL: https://doi.org/10.1016/j.jinf.2024.106229
DOI: 10.1016/j.jinf.2024.106229
Data Access Statement: Case-level deidentified participant data and data dictionary will be available from the corresponding author (hoeniglmartin@ gmail.com or oliver.cornely@uk-koeln.de) on request from the time of publication, after approval of study proposals by the ECMM Candida III steering committee, confirming that planned analyses will not overlap with other planned sub analyses of the dataset.
PubMed id: 39025408
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