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J Antimicrob Chemother. 2019 Feb 15. pii: dkz051. doi: 10.1093/jac/dkz051. [Epub ahead of print]

Development and validation of the European QUALity (EQUAL) score for mucormycosis management in haematology.

Author information

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.
Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology and Immunology, Excellence Centre for Medical Mycology (ECMM), KU Leuven, Leuven, Belgium.
Department of Laboratory Medicine and National Reference Centre for Mycosis, Excellence Centre for Medical Mycology (ECMM), University Hospitals Leuven, Leuven, Belgium.
Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.
Division of Infectious Diseases, Department of Medicine, UCSD, San Diego, CA, USA.
Division of Hygiene and Medical Microbiology, Excellence Centre for Medical Mycology (ECMM), Medical University of Innsbruck, Innsbruck, Austria.
Department of Medical Microbiology and Infectious Diseases, Excellence Centre for Medical Mycology (ECMM), Centre of Expertise in Mycology Radboudumc/CWZ, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Mycology Reference Centre, Excellence Centre for Medical Mycology (ECMM), Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Division of Infection, Immunity and Respiratory Medicine, Excellence Centre for Medical Mycology (ECMM), The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.



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.


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