Department I for Internal Medicine, Excellence Centre for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany.
CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.
J Antimicrob Chemother. 2019 Jun 1;74(6):1704-1712. doi: 10.1093/jac/dkz051.
Mucormycosis is a life-threatening infection in immunocompromised patients and in haematological malignancy patients in particular.
Our aim was to develop and evaluate a scoring tool to measure adherence to current guidelines for mucormycosis.
Current guidelines of scientific societies on mucormycosis management were reviewed. We assembled diagnostic, treatment and follow-up milestones and designed the EQUAL Mucormycosis Score. The EQUAL Mucormycosis Score was evaluated in the ECMM Excellence Centres.
An 18-item tool with one to three points per item resulted in a maximum achievable score depending on disease complexity and ranging from 25 to 32 points. Given variable patient disease course, the diagnostic score is higher in patients with positive fungal culture and biopsy, thus reflecting more decision points and higher management complexity. Eleven patients from two centres were included during the study period. A total of 200 EQUAL Mucormycosis Score points were achieved, which is 62.7% of the maximum EQUAL Mucormycosis Score of 319 points achievable in that cohort (median 18 points, range 7-27). The total score accomplished for diagnostic procedures was 112 of 165 points (67.9%), for first-line treatment 54 of 88 (61.4%) and for follow-up management 34 of 66 points (51.5%).
The EQUAL Mucormycosis Score quantitates adherence to current guideline recommendations for mucormycosis management. With 62.7% of maximum achievable score points, a first result is obtained that may serve as a reference for future evaluations. It remains to be shown whether guideline adherence and mortality rates correlate.
毛霉菌病是免疫功能低下患者，尤其是血液恶性肿瘤患者的一种危及生命的感染。
我们旨在开发和评估一种评分工具，以衡量对毛霉菌病管理当前指南的遵循情况。
审查了科学学会关于毛霉菌病管理的现行指南。我们收集了诊断、治疗和随访的里程碑，并设计了 EQUAL 毛霉菌病评分。EQUAL 毛霉菌病评分在 ECMM 卓越中心进行了评估。
一个 18 项的工具，每个项目得分为 1 至 3 分，根据疾病的复杂性，最高得分为 25 至 32 分。鉴于患者疾病的多变性，阳性真菌培养和活检的患者诊断评分较高，从而反映出更多的决策点和更高的管理复杂性。在研究期间，从两个中心纳入了 11 名患者。共获得了 200 个 EQUAL 毛霉菌病评分点，占该队列中可获得的 319 个 EQUAL 毛霉菌病评分最高得分的 62.7%（中位数 18 分，范围 7-27）。完成的诊断程序总分为 165 分中的 112 分（67.9%），一线治疗为 88 分中的 54 分（61.4%），随访管理为 66 分中的 34 分（51.5%）。
EQUAL 毛霉菌病评分定量评估了对毛霉菌病管理当前指南建议的遵循情况。获得了最高得分的 62.7%，这是一个可以作为未来评估参考的初步结果。指南的遵循情况和死亡率是否相关仍有待观察。
