P-1030. Mortality attributable to candidemia: Results from the European Confederation of Medical Mycology Multinational Observational Cohort Study Candida III
Authors: Salmanton-Garcia Jon , Cornely Oliver A , Stemler Jannik , Barać Aleksandra , Steinmann Jörg , Siváková Alena , Akalin Emin Halis , Arıkan-Akdaglı Sevtap , Loughlin Laura , Toscano Cristina , Narayanan Manjusha , Rogers Benedict , Willinger Birgit , Akyol Deniz , Roilides Emmanuel , Lagrou Katrien , Mikulska Malgorzata , Denis Blandine , Ponscarme Diane , Scharmann Ulrike , Azap Alpay , Lockhart Deborah , Bicanic Tihana , Kron Florian , Erben Nurettin , Rautemaa-Richardson Riina , Goodman Anna L , Garcia-Vidal Carolina , Lass-Flörl Cornelia , Gangneux Jean-Pierre , Taramasso Lucia , Ruiz Maite , Schick Yael , Van Wijngaerden Eric , Milacek Christopher , Giacobbe Daniele Roberto , Logan Clare , Rooney Emily , Gori Andrea , Akova Murat , Bassetti Matteo , Hoenigl Martin , Koehler Philipp 
Published: January 2025

Abstract

Background
Despite advances in antifungals, Candida infections still have a high mortality rate of up to 40%. The ECMM Candida III study in Europe investigated the changing epidemiology and outcomes, highlighting the need to understand and manage these infections.

Methods
In this observational cohort study, participating hospitals enrolled the first ten consecutive adults with confirmed candidemia. Data collected included patient demographics, risk factors, hospital stay length (with a 90-day follow-up), diagnostic procedures, Candida species, treatment details, and outcome. Controls were matched in a 1:1 ratio from the same hospitals, ensuring similarity in age, underlying illness, ICU versus normal ward stay, and recent major surgery. The study described overall and attributable mortality and assessed survival probability for both cases and controls.

Results
The study included 171 pairs consisting of patients with candidemia and matched controls from 28 institutions. In those with candidemia, overall mortality was 40.4%. The attributable mortality was 18.1% overall but differed among the causative Candida species (7.7% for Candida albicans, 23.7% for Candida glabrata, 7.7% for Candida parapsilosis, and 63.6% for Candida tropicalis). Regarding risk factors, the presence of central venous catheter, total parenteral nutrition, and acute or chronic kidney disease were significantly more common in cases versus controls. Length of hospitalization and ICU stay were significantly longer in candidemia cases (20 days (IQR 10-33) vs. 15 days (IQR 7-28); p=0.004).

Conclusion
Although overall mortality remains high in this matched case/control analysis, attributable mortality has decreased compared to historical cohorts. This may be due to a better prognosis for candidemia caused by Candida albicans, which has an attributable mortality of 7.7%, while candidemia cases caused by non-albicans Candida exhibit higher attributable mortality.

Disclosures
Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Abbvie: Honoraria|AiCuris: Advisor/Consultant|Akademie fur Infektionmedizin: Honoraria|Al-Jazeera Pharmaceuticals/Hikma: Honoraria|amedes: Honoraria|AstraZeneca: Honoraria|Basilea: Advisor/Consultant|Biocon: Advisor/Consultant|BMBF: Grant/Research Support|Boston Strategic Partners: Advisor/Consultant|CIdara: Advisor/Consultant|CIdara: Expert Testimony|CIdara: Grant/Research Support|CIdara: Participation on a DRC or DSMB|CoRe Consulting: Stocks/Bonds (Private Company)|Deutscher Arzteverlag: Honoraria|DZIF: Grant/Research Support|EasyRadiology: Stocks/Bonds (Private Company)|EU-DG RTD: Grant/Research Support|F2G: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Gilead: Honoraria|Grupo Biotoscana/United Medical/Knight: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|IQVIA: Advisor/Consultant|IQVIA: Participation on a DRC or DSMB|Janssen: Advisor/Consultant|Janssen: Participation on a DRC or DSMB|Matinas: Advisor/Consultant|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedPace: Participation on a DRC or DSMB|Medscape/WebMD: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Moderna: Honoraria|Molecular Partners: Advisor/Consultant|MSD: Grant/Research Support|MSD: Honoraria|MSG-ERC: Advisor/Consultant|Mundipharma: Advisor/Consultant|Mundipharma: Grant/Research Support|Mundipharma: Honoraria|Noscendo: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Pardes: Advisor/Consultant|Partner Therapeutics: Advisor/Consultant|Patent: US18/562644|Paul-Martini-Stiftung: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|PSI: Advisor/Consultant|PSI: Participation on a DRC or DSMB|Pulmocide: Participation on a DRC or DSMB|Sandoz: Honoraria|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seqirus: Advisor/Consultant|Seqirus: Honoraria|Seres: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi: Honoraria|streamedup!: Honoraria|The Prime Meridian Group: Advisor/Consultant|Touch Independent: Honoraria|Vitis: Honoraria Jean-Pierre Gangneux, Prof., Gilead: Honoraria|MundiPharma: Advisor/Consultant|MundiPharma: Honoraria|Pfizer: Honoraria|Shionogi: Honoraria Matteo Bassetti, PhD, Angelini: Advisor/Consultant|Angelini: Honoraria|Astellas: Advisor/Consultant|Astellas: Honoraria|bioMerieux: Advisor/Consultant|bioMerieux: Honoraria|Cidara: Advisor/Consultant|Cidara: Honoraria|Gilead: Advisor/Consultant|Gilead: Honoraria|Menarini: Advisor/Consultant|Menarini: Honoraria|MSD: Advisor/Consultant|MSD: Honoraria|Nabriva: Advisor/Consultant|Nabriva: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria|Tetraphase: Advisor/Consultant|Tetraphase: Honoraria