Utility of the EQUAL Candida Score for Assessing Adherence to Candidemia Management Guidelines: A Single-Center Experience.

BACKGROUND

Candidemia remains challenging, with high morbidity and mortality. The association between clinical characteristics, disease severity, infectious disease consultation, and the EQUAL Candida Score was investigated.

MATERIALS AND

METHODS

We conducted a retrospective cohort study of hospitalized adults with candidemia at Melaka Hospital from January 1, 2020, to December 31, 2024. Demographics, comorbidities, clinical characteristics, microbiological descriptions, clinical outcomes, and treatment details were analyzed.

RESULTS

A total of 115 cases of candidemia were included in this study. The median EQUAL Candida Score was 12 (interquartile range (IQR) 3) for patients with central venous catheters (CVC) and 11 (IQR 2) for those without CVC. Of 115 subjects, 81 (70.4%) adhered to the candidemia guidelines, with a median EQUAL Candida Score of 14 (range 13-15) in the CVC group and 12 (range 11-13) in the non-CVC group (p < 0.001). However, the overall 90-day mortality rate was alarmingly high at 62%, with the adherent group experiencing an even greater rate of 64.2% when compared with the non-adherent group (p = 0.587). The regression analysis identified key risk factors significantly contributing to the high mortality rate, including severe sepsis, the need for critical care admissions, mechanical ventilation use, the absence of infectious disease consultations, the acquisition of Candida tropicalis, and inadequate antifungal therapy.

CONCLUSIONS

Despite the high overall mortality rate in patients with candidemia, most patients in our study had a high EQUAL Candida Score, indicating good adherence to the management guidelines for candidemia. Our findings suggest that illness severity, adequacy of antifungal therapy, and timely involvement in infectious diseases strongly influence patient outcomes. Early recognition and prompt, appropriate management remain essential to improving survival.