Experience of implementation of ECMM EQUAL Scores in treatment of children at risk of invasive mycosis

The ECMM EQUAL Scores tool was proposed in 2018 as a way to improve the quality of treatment of invasive mycoses and assess compliance with the diagnostic algorithm. Currently, there are no reports of its practical application in pediatrics. This study aimed to assess the prevalence of invasive mycosis in a pediatric hospital, the attributed mortality in children with invasive mycosis, and to analyze the dynamics of consumption of antifungal drugs. By design, the study was multidirectional observational, and spanned two years, with retrospective part over the period from 01.01.2022 to 31.12.2022, and prospective part — from 01.01.2023 to 31.08.2024. We used ECMM EQUAL Scores to evaluate the conformity of the fungal infection prevention measures and the empirical therapy to the established risk tier the patients were allocated to, and calculated the ATC/DDD index to measure the consumption of antifungal drugs. During the 20-month follow-up period, 78 children survived, 20 died; supervision continues. The attributed mortality rate was 25.6%. The weighted average absolute ECMM EQUAL Scores were as follows: for candidiasis — 8.4 (38%), for aspergillosis — 6.6 (24%), and for mucormycosis — 9.85 (31%). With the help of the ATC/DDD index, we assessed the dynamics of consumption of antifungal drugs in 2022 and 2023, the "before" and "after" periods. It was concluded that introduction of the ECMM tool into the invasive mycosis diagnostic routine significantly raised the number of detected cases (from 5 to 98 per year), and pushed down the attributed mortality from 60% to 25.6%. With ECMM EQUAL Scores, the NNT index was 2.9. Before introduction of the ECMM tool, in 2022, antifungal drugs were given for 30.3 DDD per 100 bed-days, after the introduction in 2023 — 54.7 DDD per 100 bed-days.