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Attributable mortality of candidemia - Results from the ECMM Candida III multinational European Observational Cohort Study
J. Salmanton-García, OA. Cornely, J. Stemler, A. Barać, J. Steinmann, A. Siváková, EH. Akalin, S. Arikan-Akdagli, L. Loughlin, C. Toscano, M. Narayanan, B. Rogers, B. Willinger, D. Akyol, E. Roilides, K. Lagrou, M. Mikulska, B. Denis, D....
Language English Country England, Great Britain
Document type Journal Article, Observational Study, Multicenter Study
- MeSH
- Antifungal Agents therapeutic use MeSH
- Candida * isolation & purification classification MeSH
- Adult MeSH
- Candidemia * mortality microbiology MeSH
- Cohort Studies MeSH
- Middle Aged MeSH
- Humans MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Case-Control Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Europe MeSH
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.
Ankara University IDCM Ankara Turkey
Belfast Health and Social Care Trust Belfast United Kingdom
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas Madrid Spain
Department of Infectious Diseases Hospital Clínic de Barcelona Barcelona Spain
Department of Medical Microbiology Hacettepe University Medical School Ankara Turkey
Ege Univerisity Infectious Diseases and Clinical Microbiology Izmir Turkey
FOM University of Applied Sciences Essen Germany
German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany
IRCCS Ospedale Policlinico San Martino di Genova Genoa Italy
Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom
Saint Louis Hospital Paris France
University of Rennes CHU Rennes Inserm EHESP Irset UMR_S 1085 Rennes France
References provided by Crossref.org
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- $a Salmanton-García, Jon $u University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
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- $a Attributable mortality of candidemia - Results from the ECMM Candida III multinational European Observational Cohort Study / $c J. Salmanton-García, OA. Cornely, J. Stemler, A. Barać, J. Steinmann, A. Siváková, EH. Akalin, S. Arikan-Akdagli, L. Loughlin, C. Toscano, M. Narayanan, B. Rogers, B. Willinger, D. Akyol, E. Roilides, K. Lagrou, M. Mikulska, B. Denis, D. Ponscarme, U. Scharmann, A. Azap, D. Lockhart, T. Bicanic, F. Kron, N. Erben, R. Rautemaa-Richardson, AL. Goodman, C. Garcia-Vidal, C. Lass-Flörl, JP. Gangneux, L. Taramasso, M. Ruiz, Y. Schick, E. Van Wijngaerden, C. Milacek, DR. Giacobbe, C. Logan, E. Rooney, A. Gori, M. Akova, M. Bassetti, M. Hoenigl, P. Koehler
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- $a 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.
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- $a Barać, Aleksandra $u Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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