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- Hoenigl, M., et al.
(författare)
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Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study
- 2023
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Ingår i: Lancet. Infectious Diseases. - : Elsevier BV. - 1473-3099 .- 1474-4457. ; 23:6, s. 751-761
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Tidskriftsartikel (refereegranskat)abstract
- Background The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of patients with culture-proven candidaemia across Europe to assess how adherence to guideline recommendations is associated with outcomes.Methods In this observational cohort study, 64 participating hospitals located in 20 European countries, with the number of eligible hospitals per country determined by population size, included the first ten consecutive adults with culture-proven candidaemia after July 1, 2018, and entered data into the ECMM Candida Registry (FungiScope CandiReg). We assessed ECMM Quality of Clinical Candidaemia Management (EQUAL Candida) scores reflecting adherence to recommendations of the European Society of Clinical Microbiology and Infectious Diseases and the Infectious Diseases Society of America guidelines.Findings 632 patients with candidaemia were included from 64 institutions. Overall 90-day mortality was 43% (265/617), and increasing age, intensive care unit admission, point increases in the Charlson comorbidity index score, and Candida tropicalis as causative pathogen were independent baseline predictors of mortality in Cox regression analysis. EQUAL Candida score remained an independent predictor of mortality in the multivariable Cox regression analyses after adjusting for the baseline predictors, even after restricting the analysis to patients who survived for more than 7 days after diagnosis (adjusted hazard ratio 1 & BULL;08 [95% CI 1 & BULL;04-1 & BULL;11; p<0 & BULL;0001] in patients with a central venous catheter and 1 & BULL;09 [1 & BULL;05-1 & BULL;13; p<0 & BULL;0001] in those without one, per one score point decrease). Median duration of hospital stay was 15 days (IQR 4-30) after diagnosis of candidaemia and was extended specifically for completion of parenteral therapy in 100 (16%) of 621 patients. Initial echinocandin treatment was associated with lower overall mortality and longer duration of hospital stay among survivors than treatment with other antifungals.Interpretation Although overall mortality in patients with candidaemia was high, our study indicates that adherence to clinical guideline recommendations, reflected by higher EQUAL Candida scores, might increase survival. New antifungals, with similar activity as current echinocandins but with longer half-lives or oral bioavailability, are needed to reduce duration of hospital stay.
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- Burchard, H., et al.
(författare)
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Dynamics of medium-intensity dense water plumes in the Arkona Basin, Western Baltic Sea
- 2005
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Ingår i: Ocean Dynamics. - : Springer Science and Business Media LLC. - 1616-7341 .- 1616-7228. ; 55:5-6, s. 391-402
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Tidskriftsartikel (refereegranskat)abstract
- In this study, the dynamics of medium-intensity inflow events over Drogden Sill into the Arkona Sea are investigated. Idealised model simulations carried out with the General Estuarine Transport Model suggest that most of the salt transport during such inflow events occur north of Kriegers Flak, a shoal with less than 20 in water depth Surrounded by water depths of more than 40 in. This assumption about the pathway is supported by recent ship-based observations in the Arkona Sea during a medium-intensity inflow event. The propagation of a saline bottom plume could be observed during several days after having passed Drogden Sill. In the area north of Kriegers Flak the plume was about 10 m thick, and propagated with more than 0.5 m s(-1) and a salinity of tip to 20 psu (with ambient water salinity being 8 psu) eastwards. Although the model simulations were idealised, the Structural agreement between the observation and model result was good, The structure and pathways of these medium-intensity inflow events are of specific interest due to the plans for erecting extensive offshore wind farms in the Arkona Sea which may under certain circumstances lead to increased entrainment of ambient water into the bottom Plumes.
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