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Attributable mortality of candidemia – Results from the ECMM Candida III multinational European Observational Cohort Study
Open accessAbstract
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.
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“Compared with C. albicans, these species more frequently exhibit antifungal resistance and might be associated with higher mortality rates for patients with candidemia (12–14).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [14]
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Metadata
- Authors
- Salmanton-García, J., Cornely, O. A., Stemler, J., Barać, A., Steinmann, J., Siváková, A., Akalin, E. H., Arikan-Akdagli, S., Loughlin, L., Toscano, C., Narayanan, M., Rogers, B., Willinger, B., Akyol, D., Roilides, E., Lagrou, K., Mikulska, M., Denis, B., Ponscarme, D., Scharmann, U., Azap, A., Lockhart, D., Bicanic, T., Kron, F., Erben, N., Rautemaa-Richardson, R., Goodman, A. L., Garcia-Vidal, C., Lass-Flörl, C., Gangneux, J.-P., Taramasso, L., Ruiz, M., Schick, Y., Van Wijngaerden, E., Milacek, C., Giacobbe, D. R., Logan, C., Rooney, E., Gori, A., Akova, M., Bassetti, M., Hoenigl, M., & Koehler, P.
- Affiliations
- University of Cologne (DE)
- Paracelsus Medizinische Privatuniversität (DE)
- Masaryk University (CZ)
- Belfast Health and Social Care Trust (GB)
- Hospital de Egas Moniz (PT)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- University Hospitals of Leicester NHS Trust (GB)
- Medical University of Vienna (AT)
- Ege University (TR)
- Aristotle University of Thessaloniki (GR)
- KU Leuven (BE)
- Assistance Publique – Hôpitaux de Paris (FR)
- Hôpital Saint-Louis (FR)
- Essen University Hospital (DE)
- Ankara University (TR)
- University of Aberdeen (GB)
- National Health Service (GB)
- Eskişehir Osmangazi University (TR)
- Inserm (FR)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Ospedale Policlinico San Martino (IT)
- Manchester University NHS Foundation Trust (GB)
- Hacettepe University (TR)
- Medical University of Graz (AT)
- Corresponding author
- Cornely, Oliver A.
- Hoenigl, Martin
- ORCID
- Salmanton-García, Jon
- Cornely, Oliver A.
- Stemler, Jannik
- Barać, Aleksandra
- Siváková, Alena
- Loughlin, Laura
- Toscano, Cristina
- Narayanan, Manjusha
- Rogers, Benedict
- Willinger, Birgit
- Akyol, Deniz
- Roilides, Emmanuel
- Lagrou, Katrien
- Denis, Blandine
- Azap, Alpay
- Lockhart, Deborah
- Bicanic, Tihana
- Kron, Florian
- Erben, Nurettin
- Rautemaa-Richardson, Riina
- Goodman, Anna L.
- Garcia-Vidal, Carolina
- Gangneux, Jean-Pierre
- Taramasso, Lucia
- Ruiz, Maite
- Milacek, Christopher
- Giacobbe, Daniele Roberto
- Logan, Clare
- Rooney, Emily
- Gori, Andrea
- Akova, Murat
- Bassetti, Matteo
- Hoenigl, Martin
- Koehler, Philipp
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2024-09
- Volume
- 89
- Issue
- 3
- Pages
- 106229
- ISSN
- 0163-4453 (ISSN-L)
- OpenAlex
- W4400673495
- Cited by
- 127
- References
- 43
- Citations by year
- 2026: 61 · 2025: 61 · 2024: 5
- FWCI
- 44.01
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Infection (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Lirias (KU Leuven) (submittedVersion, cc-by)
- St George's Online Research Archive (St George's University of London) (submittedVersion)
- Bursa Uludag University - AVESIS (submittedVersion)
- HAL (submittedVersion, cc-by)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion, other-oa)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity) (cc-by)
- Funders
- National Institute for Health and Care Research (NIHR 203308)
- Manchester Biomedical Research Centre (NIHR 203308)
- Medical Research Council (MC_UU_00004/05)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
- Keywords
- candidemia, attributable mortality, Candida species, Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, risk factors, central venous catheters, total parenteral nutrition, kidney disease, ICU length of stay, antifungal therapy
- MeSH terms
- Adult, Aged, Aged, 80 and over, Antifungal Agents, Candida, Europe, Female, Humans, Male, Middle Aged, Risk Factors, Cohort Studies, Case-Control Studies, Candidemia
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