Quantifying guideline adherence in mucormycosis management using the EQUAL score
Summary Objectives Mucormycosis is a difficult‐to‐diagnose life‐threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the manageme...
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Veröffentlicht in: | Mycoses 2020-04, Vol.63 (4), p.343-351 |
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creator | Koehler, Philipp Mellinghoff, Sibylle C. Stemler, Jannik Otte, Felix Berkhoff, Ariana Beste, Nedim Budin, Sofia Cornely, Florian B. Evans, Johanna M. Fuchs, Frieder Pesch, Luca Rebholz, Arvid W. Reiner, Omer Schmitt, Marius Schuckelt, Julien Spiertz, Arlene Salmanton‐García, Jon Kron, Florian Cornely, Oliver A. |
description | Summary
Objectives
Mucormycosis is a difficult‐to‐diagnose life‐threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany.
Methods
We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics.
Results
Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First‐line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6‐30).
Conclusions
We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome. |
doi_str_mv | 10.1111/myc.13047 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2330792159</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2330792159</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3887-dbb75c58011c0ab01c2a532be7e47804a0ecf4e6191a64db36d1bf371fba22ed3</originalsourceid><addsrcrecordid>eNp10E9LwzAYBvAgipvTg19AAl70UJc0bdMex5h_YKIDd_AU0vTtltGms2mQfnszNz0I5pLLL8-b90HokpI76s-47tUdZSTiR2hII5YFJCb8GA1JxljAI8IH6MzaDSGUZ2FyigaMpjxhIR-i14WTptNlr80Kr5wuoNIGsCzW0IJRgLXBtVNN62c0VltcSyNXUIPpsLO7R90a8GyxnMyx9QzO0UkpKwsXh3uElvezt-ljMH95eJpO5oFiacqDIs95rOKUUKqIzAlVoYxZmAOHiKckkgRUGUFCMyqTqMhZUtC8ZJyWuQxDKNgI3exzt23z4cB2otZWQVVJA42zImSM-G1pnHl6_YduGtca_zuveJYlJGWRV7d7pdrG2hZKsW11LdteUCJ2NQtfgfiu2durQ6LLayh-5U-vHoz34FNX0P-fJJ7fp_vIL3r6hn0</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2379960834</pqid></control><display><type>article</type><title>Quantifying guideline adherence in mucormycosis management using the EQUAL score</title><source>Wiley Online Library Journals Frontfile Complete</source><creator>Koehler, Philipp ; Mellinghoff, Sibylle C. ; Stemler, Jannik ; Otte, Felix ; Berkhoff, Ariana ; Beste, Nedim ; Budin, Sofia ; Cornely, Florian B. ; Evans, Johanna M. ; Fuchs, Frieder ; Pesch, Luca ; Rebholz, Arvid W. ; Reiner, Omer ; Schmitt, Marius ; Schuckelt, Julien ; Spiertz, Arlene ; Salmanton‐García, Jon ; Kron, Florian ; Cornely, Oliver A.</creator><creatorcontrib>Koehler, Philipp ; Mellinghoff, Sibylle C. ; Stemler, Jannik ; Otte, Felix ; Berkhoff, Ariana ; Beste, Nedim ; Budin, Sofia ; Cornely, Florian B. ; Evans, Johanna M. ; Fuchs, Frieder ; Pesch, Luca ; Rebholz, Arvid W. ; Reiner, Omer ; Schmitt, Marius ; Schuckelt, Julien ; Spiertz, Arlene ; Salmanton‐García, Jon ; Kron, Florian ; Cornely, Oliver A.</creatorcontrib><description>Summary
Objectives
Mucormycosis is a difficult‐to‐diagnose life‐threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany.
Methods
We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics.
Results
Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First‐line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6‐30).
Conclusions
We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.</description><identifier>ISSN: 0933-7407</identifier><identifier>EISSN: 1439-0507</identifier><identifier>DOI: 10.1111/myc.13047</identifier><identifier>PMID: 31876327</identifier><language>eng</language><publisher>Germany: Wiley Subscription Services, Inc</publisher><subject>Amphotericin B ; Cell culture ; diagnosis ; follow‐up ; isavuconazole ; liposomal amphotericin B ; Management ; Morbidity ; Mortality ; mucorales ; Mucormycosis ; Neutropenia ; Patients ; Posaconazole ; Prophylaxis ; Quality control ; Stem cell transplantation ; treatment ; zygomycosis</subject><ispartof>Mycoses, 2020-04, Vol.63 (4), p.343-351</ispartof><rights>2019 The Authors. published by Blackwell Verlag GmbH</rights><rights>2019 The Authors. Mycoses published by Blackwell Verlag GmbH.</rights><rights>2020 Blackwell Verlag GmbH</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3887-dbb75c58011c0ab01c2a532be7e47804a0ecf4e6191a64db36d1bf371fba22ed3</citedby><cites>FETCH-LOGICAL-c3887-dbb75c58011c0ab01c2a532be7e47804a0ecf4e6191a64db36d1bf371fba22ed3</cites><orcidid>0000-0003-3928-2503 ; 0000-0001-9152-2469 ; 0000-0002-6766-8297 ; 0000-0001-9599-3137 ; 0000-0002-7386-7495</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fmyc.13047$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fmyc.13047$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31876327$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koehler, Philipp</creatorcontrib><creatorcontrib>Mellinghoff, Sibylle C.</creatorcontrib><creatorcontrib>Stemler, Jannik</creatorcontrib><creatorcontrib>Otte, Felix</creatorcontrib><creatorcontrib>Berkhoff, Ariana</creatorcontrib><creatorcontrib>Beste, Nedim</creatorcontrib><creatorcontrib>Budin, Sofia</creatorcontrib><creatorcontrib>Cornely, Florian B.</creatorcontrib><creatorcontrib>Evans, Johanna M.</creatorcontrib><creatorcontrib>Fuchs, Frieder</creatorcontrib><creatorcontrib>Pesch, Luca</creatorcontrib><creatorcontrib>Rebholz, Arvid W.</creatorcontrib><creatorcontrib>Reiner, Omer</creatorcontrib><creatorcontrib>Schmitt, Marius</creatorcontrib><creatorcontrib>Schuckelt, Julien</creatorcontrib><creatorcontrib>Spiertz, Arlene</creatorcontrib><creatorcontrib>Salmanton‐García, Jon</creatorcontrib><creatorcontrib>Kron, Florian</creatorcontrib><creatorcontrib>Cornely, Oliver A.</creatorcontrib><title>Quantifying guideline adherence in mucormycosis management using the EQUAL score</title><title>Mycoses</title><addtitle>Mycoses</addtitle><description>Summary
Objectives
Mucormycosis is a difficult‐to‐diagnose life‐threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany.
Methods
We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics.
Results
Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First‐line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6‐30).
Conclusions
We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.</description><subject>Amphotericin B</subject><subject>Cell culture</subject><subject>diagnosis</subject><subject>follow‐up</subject><subject>isavuconazole</subject><subject>liposomal amphotericin B</subject><subject>Management</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>mucorales</subject><subject>Mucormycosis</subject><subject>Neutropenia</subject><subject>Patients</subject><subject>Posaconazole</subject><subject>Prophylaxis</subject><subject>Quality control</subject><subject>Stem cell transplantation</subject><subject>treatment</subject><subject>zygomycosis</subject><issn>0933-7407</issn><issn>1439-0507</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><recordid>eNp10E9LwzAYBvAgipvTg19AAl70UJc0bdMex5h_YKIDd_AU0vTtltGms2mQfnszNz0I5pLLL8-b90HokpI76s-47tUdZSTiR2hII5YFJCb8GA1JxljAI8IH6MzaDSGUZ2FyigaMpjxhIR-i14WTptNlr80Kr5wuoNIGsCzW0IJRgLXBtVNN62c0VltcSyNXUIPpsLO7R90a8GyxnMyx9QzO0UkpKwsXh3uElvezt-ljMH95eJpO5oFiacqDIs95rOKUUKqIzAlVoYxZmAOHiKckkgRUGUFCMyqTqMhZUtC8ZJyWuQxDKNgI3exzt23z4cB2otZWQVVJA42zImSM-G1pnHl6_YduGtca_zuveJYlJGWRV7d7pdrG2hZKsW11LdteUCJ2NQtfgfiu2durQ6LLayh-5U-vHoz34FNX0P-fJJ7fp_vIL3r6hn0</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Koehler, Philipp</creator><creator>Mellinghoff, Sibylle C.</creator><creator>Stemler, Jannik</creator><creator>Otte, Felix</creator><creator>Berkhoff, Ariana</creator><creator>Beste, Nedim</creator><creator>Budin, Sofia</creator><creator>Cornely, Florian B.</creator><creator>Evans, Johanna M.</creator><creator>Fuchs, Frieder</creator><creator>Pesch, Luca</creator><creator>Rebholz, Arvid W.</creator><creator>Reiner, Omer</creator><creator>Schmitt, Marius</creator><creator>Schuckelt, Julien</creator><creator>Spiertz, Arlene</creator><creator>Salmanton‐García, Jon</creator><creator>Kron, Florian</creator><creator>Cornely, Oliver A.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>M7N</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3928-2503</orcidid><orcidid>https://orcid.org/0000-0001-9152-2469</orcidid><orcidid>https://orcid.org/0000-0002-6766-8297</orcidid><orcidid>https://orcid.org/0000-0001-9599-3137</orcidid><orcidid>https://orcid.org/0000-0002-7386-7495</orcidid></search><sort><creationdate>202004</creationdate><title>Quantifying guideline adherence in mucormycosis management using the EQUAL score</title><author>Koehler, Philipp ; Mellinghoff, Sibylle C. ; Stemler, Jannik ; Otte, Felix ; Berkhoff, Ariana ; Beste, Nedim ; Budin, Sofia ; Cornely, Florian B. ; Evans, Johanna M. ; Fuchs, Frieder ; Pesch, Luca ; Rebholz, Arvid W. ; Reiner, Omer ; Schmitt, Marius ; Schuckelt, Julien ; Spiertz, Arlene ; Salmanton‐García, Jon ; Kron, Florian ; Cornely, Oliver A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3887-dbb75c58011c0ab01c2a532be7e47804a0ecf4e6191a64db36d1bf371fba22ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amphotericin B</topic><topic>Cell culture</topic><topic>diagnosis</topic><topic>follow‐up</topic><topic>isavuconazole</topic><topic>liposomal amphotericin B</topic><topic>Management</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>mucorales</topic><topic>Mucormycosis</topic><topic>Neutropenia</topic><topic>Patients</topic><topic>Posaconazole</topic><topic>Prophylaxis</topic><topic>Quality control</topic><topic>Stem cell transplantation</topic><topic>treatment</topic><topic>zygomycosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koehler, Philipp</creatorcontrib><creatorcontrib>Mellinghoff, Sibylle C.</creatorcontrib><creatorcontrib>Stemler, Jannik</creatorcontrib><creatorcontrib>Otte, Felix</creatorcontrib><creatorcontrib>Berkhoff, Ariana</creatorcontrib><creatorcontrib>Beste, Nedim</creatorcontrib><creatorcontrib>Budin, Sofia</creatorcontrib><creatorcontrib>Cornely, Florian B.</creatorcontrib><creatorcontrib>Evans, Johanna M.</creatorcontrib><creatorcontrib>Fuchs, Frieder</creatorcontrib><creatorcontrib>Pesch, Luca</creatorcontrib><creatorcontrib>Rebholz, Arvid W.</creatorcontrib><creatorcontrib>Reiner, Omer</creatorcontrib><creatorcontrib>Schmitt, Marius</creatorcontrib><creatorcontrib>Schuckelt, Julien</creatorcontrib><creatorcontrib>Spiertz, Arlene</creatorcontrib><creatorcontrib>Salmanton‐García, Jon</creatorcontrib><creatorcontrib>Kron, Florian</creatorcontrib><creatorcontrib>Cornely, Oliver A.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>MEDLINE - Academic</collection><jtitle>Mycoses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koehler, Philipp</au><au>Mellinghoff, Sibylle C.</au><au>Stemler, Jannik</au><au>Otte, Felix</au><au>Berkhoff, Ariana</au><au>Beste, Nedim</au><au>Budin, Sofia</au><au>Cornely, Florian B.</au><au>Evans, Johanna M.</au><au>Fuchs, Frieder</au><au>Pesch, Luca</au><au>Rebholz, Arvid W.</au><au>Reiner, Omer</au><au>Schmitt, Marius</au><au>Schuckelt, Julien</au><au>Spiertz, Arlene</au><au>Salmanton‐García, Jon</au><au>Kron, Florian</au><au>Cornely, Oliver A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quantifying guideline adherence in mucormycosis management using the EQUAL score</atitle><jtitle>Mycoses</jtitle><addtitle>Mycoses</addtitle><date>2020-04</date><risdate>2020</risdate><volume>63</volume><issue>4</issue><spage>343</spage><epage>351</epage><pages>343-351</pages><issn>0933-7407</issn><eissn>1439-0507</eissn><abstract>Summary
Objectives
Mucormycosis is a difficult‐to‐diagnose life‐threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany.
Methods
We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics.
Results
Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First‐line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6‐30).
Conclusions
We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.</abstract><cop>Germany</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31876327</pmid><doi>10.1111/myc.13047</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3928-2503</orcidid><orcidid>https://orcid.org/0000-0001-9152-2469</orcidid><orcidid>https://orcid.org/0000-0002-6766-8297</orcidid><orcidid>https://orcid.org/0000-0001-9599-3137</orcidid><orcidid>https://orcid.org/0000-0002-7386-7495</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Amphotericin B Cell culture diagnosis follow‐up isavuconazole liposomal amphotericin B Management Morbidity Mortality mucorales Mucormycosis Neutropenia Patients Posaconazole Prophylaxis Quality control Stem cell transplantation treatment zygomycosis |
title | Quantifying guideline adherence in mucormycosis management using the EQUAL score |
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