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Utility of the EQUAL Candida Score for Assessing Adherence to Candidemia Management Guidelines: A Single-Center
Kai Yan Chua1, Kok Tong Tan1, Wye Hong Leong1
1Infectious Diseases Unit, Department of Medicine, Melaka Hospital, Melaka, MYS.
Background:
Candidemia remains challenging, with high morbidity and mortality. The association between clinical characteristics, disease severity, infectious disease consultation, and the EQUAL Candida Score was investigated.
Materials And Methods:
We conducted a retrospective cohort study of hospitalized adults with candidemia at Melaka Hospital from January 1, 2020, to December 31, 2024. Demographics, comorbidities, clinical characteristics, microbiological descriptions, clinical outcomes, and treatment details were analyzed.
Results:
A total of 115 cases of candidemia were included in this study. The median EQUAL Candida Score was 12 (interquartile range (IQR) 3) for patients with central venous catheters (CVC) and 11 (IQR 2) for those without CVC. Of 115 subjects, 81 (70.4%) adhered to the candidemia guidelines, with a median EQUAL Candida Score of 14 (range 13-15) in the CVC group and 12 (range 11-13) in the non-CVC group (p < 0.001). However, the overall 90-day mortality rate was alarmingly high at 62%, with the adherent group experiencing an even greater rate of 64.2% when compared with the non-adherent group (p = 0.587). The regression analysis identified key risk factors significantly contributing to the high mortality rate, including severe sepsis, the need for critical care admissions, mechanical ventilation use, the absence of infectious disease consultations, the acquisition of Candida tropicalis, and inadequate antifungal therapy.
Conclusions:
Despite the high overall mortality rate in patients with candidemia, most patients in our study had a high EQUAL Candida Score, indicating good adherence to the management guidelines for candidemia. Our findings suggest that illness severity, adequacy of antifungal therapy, and timely involvement in infectious diseases strongly influence patient outcomes. Early recognition and prompt, appropriate management remain essential to improving survival.
Insights
Candidemia poses significant risks, with high mortality despite guideline adherence. Illness severity and timely infectious disease consultation are crucial for improving patient survival in candidemia cases.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Clinical Microbiology
Background:
- Candidemia presents a significant clinical challenge, associated with high rates of morbidity and mortality.
- Understanding factors influencing candidemia outcomes is critical for improving patient care.
- The EQUAL Candida Score is a tool used to assess candidemia management.
Purpose of the Study:
- To investigate the association between clinical characteristics, disease severity, and infectious disease consultation in candidemia.
- To evaluate the utility of the EQUAL Candida Score in predicting outcomes.
- To identify risk factors for mortality in hospitalized patients with candidemia.
Main Methods:
- A retrospective cohort study was conducted involving 115 hospitalized adults with candidemia.
- Data collected included demographics, comorbidities, clinical characteristics, microbiological data, and treatment details.
- Statistical analyses, including regression, were performed to identify predictors of mortality.
Main Results:
- The median EQUAL Candida Score was 11-12, with higher scores in patients with central venous catheters.
- Despite high adherence to candidemia guidelines (70.4%), the overall 90-day mortality rate was 62%.
- Key mortality risk factors included severe sepsis, critical care admission, mechanical ventilation, lack of infectious disease consultation, Candida tropicalis infection, and inadequate antifungal therapy.
Conclusions:
- Most patients had a high EQUAL Candida Score, suggesting good guideline adherence.
- Illness severity, adequacy of antifungal therapy, and timely infectious disease consultation significantly impact patient outcomes.
- Early recognition and prompt, appropriate management are essential for improving survival in candidemia.
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