Universität zu Köln

Mellinghoff, Sibylle C., Hartmann, Pia, Cornely, Florian B., Knauth, Laura, Koehler, Felix, Koehler, Philipp ORCID: 0000-0002-7386-7495, Krause, Carolin, Kronenberg, Christine, Kranz, Sarah-Leonie, Menon, Vidya, Mueller, Hannah, Naendrup, Jan-Hendrik, Puetzfeld, Stefan, Ronge, Anna, Rutz, Jule, Seidel, Danila ORCID: 0000-0003-4388-3117, Wisplinghoff, Hilmar and Cornely, Oliver A. (2018). Analyzing candidemia guideline adherence identifies opportunities for antifungal stewardship. Eur. J. Clin. Microbiol. Infect. Dis., 37 (8). S. 1563 - 1572. NEW YORK: SPRINGER. ISSN 1435-4373

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Abstract

Candidemia epidemiology varies significantly by region; thus, local data are essential for evidence-based decision-making in prophylaxis and treatment. Current management strategies are derived from large randomized controlled trials mostly executed in large high-volume tertiary care centers. Results may not be entirely transferable to smaller hospitals. This study investigates epidemiology, diagnosis, and treatment standards in six hospitals in the Cologne metropolitan area (number of inhabitants approx. one million). We assessed adherence to the current guideline of the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and the Infectious Diseases Society of America (IDSA) using the EQUAL Candida Score of the European Confederation of Medical Mycology (ECMM). Data were documented by trained medical students as part of an integrated research and teaching concept at the University of Cologne. Between January 2014 and June 2017, 77 patients had candidemia, corresponding to an incidence of 0.2 cases/1000 admissions. While 55 patients were enrolled, 22 patients were excluded due to incompletely retrievable health records. Fluconazole monotherapy was the preferred first-line treatment in cases with Candida albicans infection (21/29). A central vascular catheter was present in 40 patients and was removed in 17 (43%) during treatment. Overall mortality at 30 days was 44%. Patients reached a mean EQUAL Candida Score of 9.9 (range 8-14), which was well below the maximum score of 22 for perfect guideline adherence. In summary, management of candidemia differed from current European recommendations. It remains unclear to what extent enhanced adherence would improve patient outcome. Larger prospective studies need to answer that question.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mellinghoff, Sibylle C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hartmann, Pia UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Florian B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Knauth, Laura UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehler, Felix UNSPECIFIED UNSPECIFIED UNSPECIFIED Koehler, Philipp UNSPECIFIED orcid.org/0000-0002-7386-7495 UNSPECIFIED Krause, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Kronenberg, Christine UNSPECIFIED UNSPECIFIED UNSPECIFIED Kranz, Sarah-Leonie UNSPECIFIED UNSPECIFIED UNSPECIFIED Menon, Vidya UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Hannah UNSPECIFIED UNSPECIFIED UNSPECIFIED Naendrup, Jan-Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Puetzfeld, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Ronge, Anna UNSPECIFIED UNSPECIFIED UNSPECIFIED Rutz, Jule UNSPECIFIED UNSPECIFIED UNSPECIFIED Seidel, Danila UNSPECIFIED orcid.org/0000-0003-4388-3117 UNSPECIFIED Wisplinghoff, Hilmar UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, Oliver A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-179163
DOI:	10.1007/s10096-018-3285-8
Journal or Publication Title:	Eur. J. Clin. Microbiol. Infect. Dis.
Volume:	37
Number:	8
Page Range:	S. 1563 - 1572
Date:	2018
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-4373
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INVASIVE FUNGAL-INFECTIONS; NEUTROPENIC ADULT PATIENTS; ESCMID-ASTERISK GUIDELINE; DOUBLE-BLIND TRIAL; ATTRIBUTABLE MORTALITY; NOSOCOMIAL CANDIDEMIA; CLINICAL MANAGEMENT; AMPHOTERICIN-B; RISK-FACTORS; CANDIDIASIS Multiple languages Infectious Diseases; Microbiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17916