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. FUNDING: Scynexis.

1st Department of Medicine Laikon General Hospital Medical School National and Kapodistrian University of Athens Athens Greece

Belfast Health and Social Care Trust Belfast UK

Centre Hospitalier de Versailles Hématologie Le Chesnay France

Clinic for Infectious and Tropical Diseases University Clinical Center of Serbia Faculty of Medicine University of Belgrade Belgrade Serbia

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany; Clinical Trials Centre Cologne Partner Site Bonn Cologne Cologne Germany

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany; Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and European Confederation of Medical Mycology Excellence Center for Medical Mycology University of Cologne Cologne Germany; Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases University of Cologne Cologne Germany; Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and European Confederation of Medical Mycology Excellence Center for Medical Mycology University of Cologne Cologne Germany; Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany; German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Department of Clinical Microbiology University Hospitals of Leicester NHS Trust Leicester UK

Department of Clinical Mycology Allergy and Immunology North Western State Medical University St Petersburg Russia

Department of Health Sciences University of Genoa Genoa Italy; Infectious Diseases Unit IRCCS Ospedale Policlinico San Martino Genoa Italy

Department of Hematology Amsterdam University Medical Centers Amsterdam Netherlands

Department of Infection Guy's and St Thomas' NHS Foundation Trust London UK; Medical Research Council Clinical Trials Unit University College London London UK

Department of Infectious Disease and Clinical Microbiology Faculty of Medicine Eskisehir Osmangazi University Eskisehir Türkiye

Department of Infectious Diseases and Clinical Microbiology Ege University Medical School Izmir Türkiye

Department of Infectious Diseases and Clinical Microbiology Faculty of Medicine Akdeniz University Antalya Türkiye

Department of Infectious Diseases and Clinical Microbiology Faculty of Medicine Bursa Uludağ University Bursa Türkiye

Department of Infectious Diseases and Clinical Microbiology Hacettepe University Medical School Ankara Türkiye

Department of Infectious Diseases and Clinical Microbiology School of Medicine Marmara University Istanbul Türkiye

Department of Infectious Diseases Centre Hospitalier Universitaire de Strasbourg Université de Strasbourg Strasbourg France

Department of Infectious Diseases Hôpital Saint Louis Fernand Widal Lariboisière Assistance Publique Hôpitaux de Paris Paris France

Department of Infectious Diseases Hospital Clínic de Barcelona Barcelona Spain

Department of Infectious Diseases Institute of Biomedicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine Infectious Diseases Unit FondazioneIRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy; Department of Pathophysiology and Transplantation and Centre for Multidisciplinary Research in Health Science University of Milan Milan Italy

Department of Medical Microbiology Aberdeen Royal Infirmary Foresterhill Aberdeen UK; Institute of Medical Sciences School of Medicine Medical Sciences and Nutrition University of Aberdeen Aberdeen UK

Department of Medical Microbiology and Infectious Diseases Canisius Wilhelmina Hospital Nijmegen Netherlands; Center of Expertise in Mycology Radboudumc CWZ Nijmegen Netherlands; Department of Medical Microbiology Radboud University Medical Center Nijmegen Netherlands

Department of Medical Microbiology Hacettepe University Medical School Ankara Türkiye

Department of Microbiology Faculty of Medicine and Dentistry Palacký University Olomouc Olomouc Czech Republic

Department of Microbiology St Anne's Faculty Hospital and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Oncohematology Comenius University and National Cancer Institute Bratislava Slovakia

Department of Parasitology Mycology Tropical Medicine Centre Hospitalier Régional Universitaire de Tours Tours France

Department of Public Health Microbiology and Virology Università degli Studi di Milano Milan Italy

Division of Clinical Microbiology Department of Laboratory Medicine Karolinska Institute Stockholm Sweden; Department of Clinical Microbiology Karolinska University Hospital Stockholm Sweden

Division of Clinical Microbiology Department of Laboratory Medicine Medical University of Vienna Vienna Austria

Division of Infectious Diseases and Hospital Epidemiology University Hospital of Basel Basel Switzerland

Division of Infectious Diseases Department of Internal Medicine Medical University of Graz Graz Austria; Translational Medical Mycology Research Unit European Confederation of Medical Mycology Excellence Center for Medical Mycology Medical University of Graz Graz Austria

Division of Infectious Diseases Department of Internal Medicine Medical University of Graz Graz Austria; Translational Medical Mycology Research Unit European Confederation of Medical Mycology Excellence Center for Medical Mycology Medical University of Graz Graz Austria; BioTechMed Graz Austria

Division of Infectious Diseases Department of Internal Medicine Medical University of Graz Graz Austria; Translational Medical Mycology Research Unit European Confederation of Medical Mycology Excellence Center for Medical Mycology Medical University of Graz Graz Austria; BioTechMed Graz Austria; Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf and European Confederation of Medical Mycology Excellence Center for Medical Mycology University of Cologne Cologne Germany

Division of Nephrology and Infectious Diseases AZ Sint Jan Brugge Oostende AV Brugge Belgium

Hospital Nuestra Señora de Sonsoles Ávila Spain

Infectious Diseases Department Hippokration General Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece

Institute of Hygiene and Medical Microbiology European Confederation of Medical Mycology Excellence Center for Medical Mycology Innsbruck Medical University Innsbruck Austria

Institute of Infection and Immunity St George's University of London London UK

Institute of Medical Microbiology University Hospital Essen University of Duisburg Essen Essen Germany

Institute of Medical Microbiology University Hospital Essen University of Duisburg Essen Essen Germany; Institute for Clinical Hygiene Medical Microbiology and Infectiology Paracelsus Medical University Klinikum Nürnberg Nuremberg Germany

Institute of Microbiology and Immunology Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Laboratory of Clinical Microbiology and Molecular Biology Centro Hospitalar de Lisboa Ocidental Lisboa Portugal

Laboratory of Clinical Microbiology Department of Microbiology Immunology and Transplantation KU Leuven Leuven Belgium; Department of Laboratory Medicine and National Reference Center for Mycosis UZ Leuven Leuven Belgium

Laboratory of Parasitology and Mycology Saint Louis University Hospital Assistance Publique Hôpitaux de Paris Paris France

Medical Mycology Reference Laboratory Institute of Microbiology and Immunology Faculty of Medicine University of Belgrade Belgrade Serbia; Centre for Microbiology Institute of Public Health of Vojvodina Novi Sad Serbia

Microbiology Department La Paz University Hospital Madrid Spain

Microbiology Division Public Health Wales Cardiff UK; Centre for Trials Research and Division of Infection and Immunity Cardiff University Cardiff UK

Mycology Reference Centre Manchester and Department of Infectious Diseases Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK; Division of Evolution Infection and Genomics Faculty of Biology Medicine and Health University of Manchester Manchester UK

Mycology Reference Laboratory National Centre for Microbiology Instituto de Salud Carlos 3 Madrid Spain

Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Northumbria Healthcare NHS Foundation Trust North Shields UK

Paris Cité Université Necker Hospital Assistance Publique Hôpitaux de Paris Paris France

Section of Infectious Diseases Department of Medicine 2 Justus Liebig University Giessen Giessen Germany

Unit of Infectious Diseases and Microbiology Institute of Biomedicine of Seville University Hospital Virgen del Rocío Seville Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas Madrid Spain

Unit of Mycology Statens Serum Institut Copenhagen Denmark; Department of Clinical Microbiology Rigshospitalet Copenhagen Denmark; Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Univ Rennes CHU Rennes Inserm EHESP Irset UMR_S 1085 Rennes France

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Lancet Infect Dis. 2023 Jun;23(6):647-648. doi: 10.1016/S1473-3099(23)00046-4. PubMed

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