Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
Department I of Internal Medicine, ECMM Center of Excellence for Medical Mycology, German Centre for Infection Research, partner site Bonn-Cologne (DZIF), University of Cologne, Cologne, Germany.
Mycoses. 2018 May;61(5):326-330. doi: 10.1111/myc.12746. Epub 2018 Feb 20.
Candida species frequently cause blood stream infections and are reported to be the third to tenth most commonly isolated pathogens. Guidelines and standardised treatment algorithms provided by professional organisations aim to facilitate decision-making regarding diagnosis, management and treatment of candidaemia. In routine clinical practise, however, it may be challenging to comply with these guidelines. The reasons include lack of familiarity or feasibility to adherence, but also their length and complexity. There is no tool to measure guideline adherence currently. To provide such a tool, we reviewed the current guidelines provided by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and by the Infectious Diseases Society of America (IDSA), and selected the strongest recommendations for management quality as the bases for our scoring tool. Factors incorporated were diagnostic (blood cultures, echocardiography, ophthalmoscopy, species identification) and follow-up procedures (repeat blood cultures until negative result) as well as key treatment parameters (echinocandin treatment, step down to fluconazole depending on susceptibility result, CVC removal). The EQUAL Candida Score weighs and aggregates factors recommended for the ideal management of candidaemia and provides a tool for antifungal stewardship as well as for measuring guideline adherence.
念珠菌属物种常引起血流感染，据报道是第三至第十种最常分离的病原体。专业组织提供的指南和标准化治疗算法旨在促进关于念珠菌血症的诊断、管理和治疗的决策。然而，在常规临床实践中，可能难以遵守这些指南。原因包括不熟悉或难以遵守，以及其长度和复杂性。目前没有衡量指南依从性的工具。为了提供这样的工具，我们回顾了欧洲临床微生物学和传染病学会 (ESCMID) 和美国传染病学会 (IDSA) 提供的现行指南，并选择了管理质量最强的建议作为我们评分工具的基础。纳入的因素包括诊断（血培养、超声心动图、眼底检查、菌种鉴定）和随访程序（重复血培养直至阴性结果）以及关键治疗参数（棘白菌素治疗、根据药敏结果降阶梯至氟康唑、CVC 移除）。EQUAL Candida 评分权衡和汇总了念珠菌血症理想管理推荐的因素，为抗真菌药物管理以及衡量指南依从性提供了工具。
