https://www.cidrap.umn.edu/antimicr...delines-may-improve-candidemia-survival-rates
Adherence to treatment guidelines may improve candidemia survival rates
News brief
Today at 3:34 p.m.
Chris Dall, MA
Topics
Antimicrobial Stewardship
Fungal Infection
A study of patients with candidemia at hospitals in 20 European countries revealed that adherence to clinical guideline recommendations may improve survival rates, researchers reported yesterday in The Lancet Infectious Diseases.
To assess how adherence to clinical guidelines is associated with outcomes in patients with culture-proven candidemia, researchers with the European Confederation of Medical Mycology (ECMM) Candida III Study Group collected data on the epidemiology, risk factors, treatment, and outcomes of 623 patients treated at 64 participating European hospitals. They assessed guideline adherence using ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores.
The overall mortality rate was 46%, with a 90-day mortality rate of 43%; 37% of deaths were directly attributable to candidemia. Increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent predictors of mortality.
Death rates decline with guideline adherence
After adjustment for baseline risk factors, adherence to clinical guidelines was identified as a major protective factor. With every one point decrease in the EQUAL Candida score (reflecting a decrease in guideline adherence), the risk of death increased by 8% (adjusted hazard ratio [aHR], 1.08; 95% confidence interval [CI], 1.04 to 1.11) for patients with a central venous catheter (CVC) and 9% (aHR, 1.09; 95% CI, 1.05 to 1,13) for patients without a CVC.
Additionally, mortality in patients for whom guideline-recommended diagnostic or therapeutic measures were not performed was higher (51% to 71%) than in the overall cohort (46%). Initial echinocandin treatment was associated with lower overall mortality but also longer hospital stays among survivors than treatment with other antifungals.
"Not-performing or not-completing each diagnostic or therapeutic measure (including initial echinocandin treatment) was associated with increased mortality compared with mortality in the overall cohort, emphasizing the importance of every single guideline recommendation in the successful management of candidaemia," the study authors wrote.
Adherence to treatment guidelines may improve candidemia survival rates
News brief
Today at 3:34 p.m.
Chris Dall, MA
Topics
Antimicrobial Stewardship
Fungal Infection
A study of patients with candidemia at hospitals in 20 European countries revealed that adherence to clinical guideline recommendations may improve survival rates, researchers reported yesterday in The Lancet Infectious Diseases.
To assess how adherence to clinical guidelines is associated with outcomes in patients with culture-proven candidemia, researchers with the European Confederation of Medical Mycology (ECMM) Candida III Study Group collected data on the epidemiology, risk factors, treatment, and outcomes of 623 patients treated at 64 participating European hospitals. They assessed guideline adherence using ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores.
The overall mortality rate was 46%, with a 90-day mortality rate of 43%; 37% of deaths were directly attributable to candidemia. Increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent predictors of mortality.
Death rates decline with guideline adherence
After adjustment for baseline risk factors, adherence to clinical guidelines was identified as a major protective factor. With every one point decrease in the EQUAL Candida score (reflecting a decrease in guideline adherence), the risk of death increased by 8% (adjusted hazard ratio [aHR], 1.08; 95% confidence interval [CI], 1.04 to 1.11) for patients with a central venous catheter (CVC) and 9% (aHR, 1.09; 95% CI, 1.05 to 1,13) for patients without a CVC.
Additionally, mortality in patients for whom guideline-recommended diagnostic or therapeutic measures were not performed was higher (51% to 71%) than in the overall cohort (46%). Initial echinocandin treatment was associated with lower overall mortality but also longer hospital stays among survivors than treatment with other antifungals.
"Not-performing or not-completing each diagnostic or therapeutic measure (including initial echinocandin treatment) was associated with increased mortality compared with mortality in the overall cohort, emphasizing the importance of every single guideline recommendation in the successful management of candidaemia," the study authors wrote.