Review

. 2024 Aug 1;189(4):70.

doi: 10.1007/s11046-024-00871-0.

Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV

Stella Wolfgruber^#^{1

2}, Sarah Sedik^#^{1

2}, Lena Klingspor³, Annamaria Tortorano⁴, Neil A R Gow⁵, Katrien Lagrou^{6

7}, Jean-Pierre Gangneux^{8

9}, Johan Maertens¹⁰, Jacques F Meis^{11

12}, Cornelia Lass-Flörl¹³, Sevtap Arikan-Akdagli¹⁴, Oliver A Cornely^{15

12

16

17}, Martin Hoenigl^{18

19

20}

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
² Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria.
³ Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
⁴ Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
⁵ Medical Research Council Centre for Medical Mycology, Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK.
⁶ Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium.
⁷ Department of Laboratory Medicine and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium.
⁸ Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, 35000, Rennes, France.
⁹ Laboratory of Mycology, Centre Hospitalier Universitaire de Rennes, Centre National de référence pour les mycoses et antifongiques - LA AspC, ECMM Excellence Center for Medical Mycology, Rennes, France.
¹⁰ Department of Haematology and ECMM Excellence Center for Medical Mycology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
¹¹ Department of Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
¹² University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
¹³ Institute of Hygiene and Medical Microbiology Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), Innsbruck, Austria.
¹⁴ Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey.
¹⁵ 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.
¹⁶ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
¹⁷ University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.
¹⁸ Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. hoeniglmartin@gmail.com.
¹⁹ Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria. hoeniglmartin@gmail.com.
²⁰ BioTechMed-Graz, Graz, Austria. hoeniglmartin@gmail.com.

^# Contributed equally.

PMID: 39088098
PMCID: PMC11294264
DOI: 10.1007/s11046-024-00871-0

Review

Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV

Stella Wolfgruber et al. Mycopathologia. 2024.

. 2024 Aug 1;189(4):70.

doi: 10.1007/s11046-024-00871-0.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
² Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria.
³ Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
⁴ Dipartimento Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
⁵ Medical Research Council Centre for Medical Mycology, Department of Biosciences, University of Exeter, Geoffrey Pope Building, Stocker Road, Exeter, UK.
⁶ Laboratory of Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Louvain, Belgium.
⁷ Department of Laboratory Medicine and National Reference Center for Mycosis, UZ Leuven, Leuven, Belgium.
⁸ Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, 35000, Rennes, France.
⁹ Laboratory of Mycology, Centre Hospitalier Universitaire de Rennes, Centre National de référence pour les mycoses et antifongiques - LA AspC, ECMM Excellence Center for Medical Mycology, Rennes, France.
¹⁰ Department of Haematology and ECMM Excellence Center for Medical Mycology, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
¹¹ Department of Medical Microbiology, Excellence Center for Medical Mycology (ECMM), Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.
¹² University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany.
¹³ Institute of Hygiene and Medical Microbiology Medical University of Innsbruck, Excellence Center for Medical Mycology (ECMM), Innsbruck, Austria.
¹⁴ Department of Medical Microbiology, Hacettepe University Medical School, Ankara, Turkey.
¹⁵ 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.
¹⁶ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
¹⁷ University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, Germany.
¹⁸ Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria. hoeniglmartin@gmail.com.
¹⁹ Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria. hoeniglmartin@gmail.com.
²⁰ BioTechMed-Graz, Graz, Austria. hoeniglmartin@gmail.com.

^# Contributed equally.

PMID: 39088098
PMCID: PMC11294264
DOI: 10.1007/s11046-024-00871-0

Abstract

Invasive candidiasis and candidemia remain a significant public health concern. The European Confederation of Medical Mycology (ECMM) conducted three pan-European multicentre studies from 1997 to 2022 to investigate various aspects of invasive Candida infections. These studies revealed shifting trends in Candida species distribution, with an increase of non-albicans Candida species as causative pathogens, increasing rates of antifungal resistance, and persistently high mortality rates. Despite advancements in antifungal treatment, the persistently high mortality rate and increasing drug resistance, as well as limited drug access in low-income countries, underscore the need for continued research and development in the treatment of Candida infections. This review aims to summarize the findings of the three completed ECMM Candida studies and emphasize the importance of continued research efforts. Additionally, it introduces the upcoming ECMM Candida IV study, which will focus on assessing candidemia caused by non-albicans Candida species, including Candida auris, investigating antifungal resistance and tolerance, and evaluating novel treatment modalities on a global scale.

Keywords: Candida; Candidemia; European Confederation of Medical Mycology (ECMM).

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Conflict of interest statement

LK received research grants from Gilead, and has received honoraria for educational lectures from Gilead, Merck, Sharpe & Dohme, and Vertex Pharmaceuticals outside the submitted work. NG acknowledges support of Wellcome Trust Investigator, Collaborative, Equipment, Strategic and Biomedical Resource awards (101873, 200208, 215599, 224323 and 200208 (the latter awarded to Daan van Aalten)) and the MRC (MR/M026663/2) and the MRC Centre for Medical Mycology (MR/N006364/2) for support. KL received consultancy fees from MRM Health and Mundipharma, speaker fees from Pfizer and Gilead, a service fee from Thermo fisher Scientific and TECOmedical and a fee for Advisory Board participation from MSD and Pfizer, JPG has received lecture honoraria from Gilead, MundiPharma and Pfizer, outside of the submitted work. JM reports research grants and/or personal fees for advisor/consultant, and/or speaker/chairman from Gilead Sciences, F2G, Shionogi, Mundipharma, Mundipharma, Takeda, and Basilea. CLF reports research grants and/or personal fees for advisor/consultant, travel and/or speaker/chairman from Gilead, MSD, Pfizer, BioMérieux, F2G, IMMY, Shionogi, Astellas Pharma. SAA reports research grant from Cidara, lecture honoraria from Gilead, and travel grant from Astellas. M. H. received research funding from Gilead, MSD, IMMY, Mundipharma, Scynexis, Melinta, Euroimmune, Shionogi, F2G and Pfizer (all outside of the submitted work). OAC reports grants or contracts from BMBF, Cidara, DZIF, EU-DG RTD, F2G, Gilead, MedPace, MSD, Mundipharma, Octapharma, Pfizer, Scynexis; Consulting fees from Abbvie, AiCuris, Basilea, Biocon, Boston Strategic Partners, Cidara, Seqirus, Gilead, GSK, IQVIA, Janssen, Matinas, MedPace, Menarini, Molecular Partners, MSG-ERC, Mundipharma, Noxxon, Octapharma, Pardes, Partner Therapeutics, Pfizer, PSI, Scynexis, Seres, Shionogi, The Prime Meridian Group; Speaker and lecture honoraria from Abbott, Abbvie, Akademie für Infektionsmedizin, Al-Jazeera Pharmaceuticals/Hikma, amedes, AstraZeneca, Deutscher Ärzteverlag, Gilead, GSK, Grupo Biotoscana/United Medical/Knight, Medscape/WebMD, MedUpdate, MSD, Moderna, Mundipharma, Noscendo, Paul-Martini-Stiftung, Pfizer, Sandoz, Seqirus, Shionogi, streamedup!, Touch Independent, Vitis; Payment for expert testimony Cidara; Participation on a DRC or DSMB for Cidara, IQVIA, Janssen, MedPace, PSI, Pulmocide. The other authors declare no conflict of interest. SW, SS, JFM no conflict of interest.

Figures

**Fig. 1**
Participating European countries in the three ECMM *Candida* studies and numbers of included cases

**Fig. 2**
A Species distribution (number of common isolates) during the three ECMM *Candida* studies, B species distribution (number of rare isolates) during the three ECMM *Candida* studies

**Fig. 3**
Summary of risk factors associated with candidemia development across three ECMM studies. The presence of risk factors observed during the studies is represented by blue circles (dark blue for Candida III, blue for Candida II and light blue for Candida I)

See this image and copyright information in PMC

References

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1. Alvarez-Moreno CA, et al. The mortality attributable to Candidemia in C. auris is higher than that in other Candida species: myth or reality? J Fungi (Basel). 2023;9(4):430. 10.3390/jof9040430 - DOI - PMC - PubMed
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Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV

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Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV

Authors

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Conflict of interest statement

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