# Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study

## TL;DR

A study of candidemia cases outside the ICU found higher survival rates despite more comorbidities, with certain factors linked to better outcomes.

## Contribution

The study provides new insights into candidemia management and outcomes in non-ICU settings across Europe.

## Key findings

- Non-ICU candidemia patients had higher survival rates despite higher comorbidity burdens.
- Older age and hematological malignancies were associated with increased mortality risk.
- Infectious disease consultation and echinocandin therapy improved survival outcomes.

## Abstract

The European Confederation of Medical Mycology Candida III was a pan-European, multicenter 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 subanalysis 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 = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan–Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, P = .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 disease 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 comorbidity rates, non-ICU patients with candidemia had higher survival rates.

A subanalysis of 396 candidemia cases diagnosed outside the intensive care unit from the pan-European multicenter ECMM Candida III study showed higher survival rates despite greater comorbidity. Increased mortality was associated with older age, hematological malignancies, chronic liver disease, and severe acute respiratory syndrome coronavirus 2 infection, whereas infectious disease or clinical microbiology consultation, initial echinocandin therapy, and higher EQUAL Candida scores were linked to improved survival.