Clinical characteristics, management and outcomes of non-ICU candidemia: Sub-analysis of the ECMM Candida III multinational European observational cohort study

Abstract ECMM-Candida III was a pan-European, multicentre observational study of adult patients with blood culture-proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a sub-analysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU-patients, non-ICU patients had a higher comorbidity burden (median Charlson Comorbidity Index [CCI] 6 vs. 5 in ICU patients, p=0.006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5%, vs 28.4%, p<0.001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (p<0.001). Non-ICU patients had significantly lower mortality in Kaplan-Meier survival analysis (p>0.001). Post-surgical non-ICU patients (n=45) had the highest survival rate (73.3%, p=0.003) and the longest hospital stay, even after excluding all cases with a fatal outcome before Day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an Infectious Diseases or Clinical Microbiology consultant, and initial treatment with an echinocandin, respectively higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher co-morbidity rates, non-ICU patients with candidemia had higher survival rates.

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Journal
Open Forum Infectious Diseases
Published
2026-03-26
DOI
https://doi.org/10.1093/ofid/ofag133
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Clinical characteristics, management and outcomes of non-ICU candidemia: Sub-analysis of the ECMM Candida III multinational European observational cohort study

Benedict Rogers, Lucia Taramasso, Christoph Zurl, Helena Hammarström et al.
Open Forum Infectious Diseases
Antifungal resistance and susceptibility
article

Clinical characteristics, management and outcomes of non-ICU candidemia: Sub-analysis of the ECMM Candida III multinational European observational cohort study

Benedict Rogers, Lucia Taramasso, Christoph Zurl, Helena Hammarström, Guillaume Désoubeaux, Aleksandra Barać, Anna L. Goodman, Manjusha Narayanan, Jens Van Praet, Karin van Dijk, Deborah Lockhart, Julio Alberto García-Rodríguez, Jörg Steinmann, Emmanuel Roilides, B. Willinger, C García-Vidal, Stella Wolfgruber, Julio Dávila, Nina Khanna, Ola Blennow, ECMM Candida III Study Group, Thomas Longval, Nick de Jonge, Michael Samarkos, E. W. Meijer, Petr Hamal, Anna Maria Peri, Alena Siváková, Janina Trauth, Uluhan Sili, Cristina Toscano, Ulrike Scharmann, François Danion, Valentina Arsić-Arsenijević, Özge Turhan, Maite Ruíz, Matjaž Jereb, Nikolai Klimko, Nurettin Erben, Tadeja Matos, Alba Ruiz-Gaitan, Riina Rautemaa-Richardson, Maria Calbacho, Sevtap Arikan-Akdagli, Laura Loughlin, J. P. Gangneux, Mario Tumbarello, Igor Stoma, Philipp Koehler, Jon Salmanton-García, Lubos Drgona, Blandine Denis, Johanna Kessel, Oliver A Cornely, Malgorzata Mikulska, Fanny Lanternier, Alpay Azap, Tihana Bicanic, Katrien Lagrou, Zdenek Racil, Sarah Sedik, Martin Hoenigl, Deniz Akyol, Cornelia Lass-Flörl, Murat Akova, Matthias Egger, P Lewis White, Avinash Aujayeb, Alida Fe Talento, Maiken Cavling Arendrup, Juergen Prattes, Sonia Martín-Pérez, Emin Halis Akalin, Matteo Bassetti
article en

Abstract

Abstract ECMM-Candida III was a pan-European, multicentre observational study of adult patients with blood culture-proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a sub-analysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU-patients, non-ICU patients had a higher comorbidity burden (median Charlson Comorbidity Index [CCI] 6 vs. 5 in ICU patients, p=0.006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5%, vs 28.4%, p<0.001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (p<0.001). Non-ICU patients had significantly lower mortality in Kaplan-Meier survival analysis (p>0.001). Post-surgical non-ICU patients (n=45) had the highest survival rate (73.3%, p=0.003) and the longest hospital stay, even after excluding all cases with a fatal outcome before Day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an Infectious Diseases or Clinical Microbiology consultant, and initial treatment with an echinocandin, respectively higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher co-morbidity rates, non-ICU patients with candidemia had higher survival rates.

Open Forum Infectious Diseases
Statens Serum Institut (DK), University of Copenhagen (DK), Belfast Health and Social Care Trust (GB), Bursa Uludağ Üni̇versi̇tesi̇ (TR), Karolinska University Hospital (SE), Innsbruck Medical University (AT), Radboud University Nijmegen (NL), University of Ljubljana (SI), Inserm (FR), St George's, University of London (GB), University of Cologne (DE), University of Aberdeen (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Justus-Liebig-Universität Gießen (DE), Medical University of Graz (AT), Université Paris Cité (FR), Trinity College Dublin (IE), Aristotle University of Thessaloniki (GR), Masaryk University (CZ), Rega Institute for Medical Research (BE), Paracelsus Medical University (AT), Manchester Academic Health Science Centre (GB), Hospital Universitario La Paz (ES), Aberdeen Royal Infirmary (GB), Northumbria Healthcare NHS Foundation Trust (GB), Newcastle upon Tyne Hospitals NHS Foundation Trust (GB), University Hospitals of Leicester NHS Trust (GB), University Hospital of Basel (CH), Rigshospitalet (DK), University Medical Center (US), Radboud University Medical Center (NL), Children's Health Ireland at Crumlin (IE), Hospital Universitari i Politècnic La Fe (ES), University of Belgrade (RS), Ege University (TR), Public Health Wales (GB), Comprehensive Cancer Center Vienna (AT), Manchester University NHS Foundation Trust (GB), Centre Hospitalier Universitaire de Tours (FR), Assistance Publique – Hôpitaux de Paris (FR), Institut de Recherche en Santé, Environnement et Travail (FR), Radboud Institute for Molecular Life Sciences (NL), Laboratoire National de Référence (MA), Canisius-Wilhelmina Ziekenhuis (NL), Laiko General Hospital of Athens (GR), Centro de Investigación Biomédica en Red (ES), Hospital Clínic de Barcelona (ES), German Center for Infection Research (DE), Paracelsus Medizinische Privatuniversität (DE), Ippokrateio General Hospital of Thessaloniki (GR), BioTechMed-Graz (AT), Hôpital Lariboisière (FR), Institute of Public Health of Vojvodina (RS), AZ Sint-Jan (BE), Centro Hospitalar de Lisboa Ocidental (PT), Instituto de Biomedicina de Sevilla (ES), Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases (DE), Hôpitaux Universitaires de Strasbourg (FR), Ospedale Policlinico San Martino (IT), Amsterdam University Medical Centers (NL), University Hospital Cologne (DE), Hospital for Tropical Diseases (VN), Centre Hospitalier de Versailles (FR), Institute of Infection and Immunity (CA), Hospital Nuestra Señora de Alarcos (ES), University College London (GB), Eskişehir Osmangazi University (TR), Université de Rennes (FR), University of Duisburg-Essen (DE), Hacettepe University (TR), Université de Strasbourg (FR), Palacký University Olomouc (CZ), Comenius University Bratislava (SK), Marmara University (TR), Medical University of Vienna (AT), Cardiff University (GB), University of Genoa (IT), University of Gothenburg (SE), Medical Research Council (GB), KU Leuven (BE)
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