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

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

Clinical Academic Group in Infection and Immunity St George's University Hospital National Health Service Foundation Trust London United Kingdom

Departement of Internal Medicine Fondazione IRCCS Cà Granda Osepdale Maggiore Policlinico Milan Italy

Department of Clinical Microbiology University Hospitals of Leicester NHS Trust Leicester United Kingdom

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

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

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

Department of Infectious Diseases Centre for Clinical Infection and Diagnostics Research Guy's and St Thomas' National Health Service Foundation Trust and King's College London and Medical Research Council Clinical Trials Unit at University College London London United Kingdom

Department of Infectious Diseases Hôpital Saint Louis Fernand Widal Lariboisière AP HP 1 Avenue Claude Vellefaux 75010 Paris France

Department of Infectious Diseases Hospital Clínic de Barcelona Barcelona Spain

Department of Infectious Diseases Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester United Kingdom

Department of Medical Microbiology Hacettepe University Medical School Ankara Turkey

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

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

Ege Univerisity Infectious Diseases and Clinical Microbiology Izmir Turkey

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

Institute for Clinical Hygiene and Medical Microbiology Paracelsus Medical University Nuremberg Germany

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

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

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

IRCCS Ospedale Policlinico San Martino di Genova Genoa Italy

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

Mycology Reference Centre Manchester ECMM Centre of Excellence and Department of Infectious Diseases Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester United Kingdom

Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne United Kingdom

Saint Louis Hospital Paris France

UGC Enfermedades Infecciosas Microbiología y Parasitología University Hospital Virgen del Rocío Seville Spain; Grupo Microbiología Clínica y Molecular Instituto de Biomedicina de Sevilla HUVR CSIC Universidad de Sevilla Seville Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas Madrid Spain

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 Cologne Germany

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 Partner Site Bonn Cologne Cologne Germany

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 University of Cologne Faculty of Medicine and University Hospital Cologne Cologne Germany

University of Rennes CHU Rennes Inserm EHESP Irset UMR_S 1085 Rennes France

VITIS Healthcare Group Cologne Germany; Department 1 of Internal Medicine Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany; Center for Integrated Oncology Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany; FOM University of Applied Sciences Essen Germany

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