Management of candidaemia with reference to the European confederation of medical mycology quality indicators

Abstract

Background: Candidaemia is associated with high mortality. The European Confederation of Medical Mycology (ECMM) has recently proposed the ECMM Quality of Clinical Candidemia Management (EQUAL) scoring criteria which provide an objective measure of adherence to various good practice recommendations. The maximum score is 22 in patients with a central venous catheter (CVC) and 19 in patients without a CVC. Our objective was to audit the management of patients with candidaemia against the ECMM recommendations. Methods: We interrogated our prospective database against individual ECMM recommendations. The audit period was from April 2011 to February 2019. Data were collected from electronic records and case-notes. Results: A total of 131 patients were audited. The mean (maximum) scores for the individual good practice recommendations were as follows: adequate volume of blood culture 0.98 (3) points, identification of Candida species 3 (3) points, antifungal susceptibility testing 1.98 (2) points, echocardiogram 0.51 (1) point, ophthalmoscopy 0.3 (1) point, initial treatment with echinocandin 1.32 (3) points, step-down therapy 0.74 (2) points, treatment for 14 days following first negative follow-up culture 1.37 (2) points, removal of CVC 1.79 (3 for removal within 24 hours or 2 for removal within 72 hours) points, and daily follow up blood cultures 0 (2) points. The overall mean EQUAL score was 11.04. The mean scores of survivors and non-survivors were 11.21 and 10.54 respectively. Performance of ophthalmoscopic examination was associated with a favourable outcome. Conclusion: The audit highlights the need for improvement in the clinical aspects of management of candidaemia.

Keywords: Candidaemia; ECMM recommendations; EQUAL score; Echinocandin; Step-down therapy.