EQUAL Score Scedosporiosis/Lomentosporiosis 2021: a European Confederation of Medical Mycology (ECMM) tool to quantify guideline adherence

Jannik Stemler; Michaela Lackner; Sharon C-A Chen; Martin Hoenigl; Oliver A Cornely

doi:10.1093/jac/dkab355

EQUAL Score Scedosporiosis/Lomentosporiosis 2021: a European Confederation of Medical Mycology (ECMM) tool to quantify guideline adherence

J Antimicrob Chemother. 2021 Dec 24;77(1):253-258. doi: 10.1093/jac/dkab355.

Authors

Jannik Stemler^{1

2

3}, Michaela Lackner⁴, Sharon C-A Chen⁵, Martin Hoenigl^{6

7

8}, Oliver A Cornely^{1

2

3

9}

Affiliations

¹ Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, NRW, Germany.
² Faculty of Medicine and University Hospital Cologne, Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, NRW, Germany.
³ German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, NRW, Germany.
⁴ Institute of Hygiene and Medical Microbiology, Department of Hygiene, Medical Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria.
⁵ Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Westmead Hospital and the University of Sydney, Sydney, Australia.
⁶ Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA.
⁷ Clinical and Translational Fungal Research-Working Group, University of California San Diego, San Diego, CA, USA.
⁸ Division of Infectious Diseases, Medical University of Graz, Graz, Austria.
⁹ University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinical Trials Centre Cologne (ZKS Köln), Cologne, NRW, Germany.

Abstract

Background: Invasive scedosporiosis and lomentosporiosis are life-threatening fungal infections in immunocompromised patients with complex diagnostic and treatment patterns.

Objectives: To develop a scoring tool to facilitate and quantify adherence to current guideline recommendations for diagnosis, treatment and follow-up of invasive scedosporiosis and lomentosporiosis.

Methods: Experts from European Confederation of Medical Mycology (ECMM) excellence centres reviewed current guidelines for scedosporiosis and lomentosporiosis. Recommendations for diagnosis, treatment and follow-up were summarized, assembled and weighted according to their strength of recommendation and level of evidence (strongly recommended = 3 points; moderately recommended = 2 points; marginally recommended = 1 point; recommended against = 0 points). Additional items considered of high importance for clinical management were also weighted.

Results: A total of 170 recommendations were identified. A 21-item tool was developed and embedded into the EQUAL score card. Nine items for diagnosis with 18 achievable points were assembled. For treatment, three general recommendation items with a maximal score of 9 were identified, while for specific antifungal treatment the two fungal pathogens were separated. Three and four items were established for scedosporiosis and lomentosporiosis, respectively, with a maximum achievable score of 3 due to the separation of different treatment options with the maximum point value of 3 for voriconazole-based treatment. Follow-up comprised two items (4 points maximum). Key recommendations for clinical outcome were weighted accordingly.

Conclusions: We propose the EQUAL Score Scedosporiosis/Lomentosporiosis to quantify adherence to current guideline recommendations for management of these rare infections. The score remains to be validated in real-life patient cohorts and correlated with patient outcome.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Antifungal Agents / therapeutic use
Guideline Adherence
Humans
Invasive Fungal Infections* / drug therapy
Mycology*

Substances

Antifungal Agents

Supplementary concepts

scedosporiosis

Grants and funding

UL1TR001442-061/NH/NIH HHS/United States