Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study

Stella Wolfgruber; Carolina Garcia-Vidal; Sarah Sedik; Jon Salmanton-García; Sevtap Arikan-Akdagli; Jean-Pierre Gangneux; Riina Rautemaa-Richardson; Valentina Arsić-Arsenijević; Sonia Martín-Pérez; Julio Dávila-Valls; Nurettin Erben; Emin Halis Akalin; Lubos Drgona; Cornelia Lass-Flörl; Julio García-Rodríguez; Tihana Bicanic; Helena Hammarström; Petr Hamal; J. rg Steinmann; Eelco F. J. Meijer; Nina Khanna; Guillaume Desoubeaux; Thomas Longval; Uluhan Sili; Janina Trauth; Matteo Bassetti; P. Lewis White; Avinash Aujayeb; Tadeja Matos; Deniz Akyol; Francois Danion; Katrien Lagrou; Benedict Rogers; Maite Ruiz; Alena Siváková; Malgorzata Mikulska; Michael Samarkos; Ola Blennow; Deborah E. A. Lockhart; Blandine Denis; Birgit Willinger; Karin van Dijk; Ulrike Scharmann; Anna L. Goodman; Jens van Praet; Manjusha Narayanan; Cristina Toscano; Laura Loughlin; Nick Alexander de Jonge; Alba Ruiz-Gaitan; Fanny Lanternier; Juergen Prattes; Emmanuel Roilides; Alida Fe Talento; Aleksandra Barac; Matthias Egger; Maiken Cavling Arendrup; Philipp Koehler; Oliver A. Cornely; Martin Hoenigl

doi:10.1093/ofid/ofag133

Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study

Stella Wolfgruber
, Carolina Garcia-Vidal
, Sarah Sedik^*
, Jon Salmanton-García
, Sevtap Arikan-Akdagli
, Jean-Pierre Gangneux
, Riina Rautemaa-Richardson
, Valentina Arsić-Arsenijević
, Sonia Martín-Pérez
, Julio Dávila-Valls
, Nurettin Erben
, Emin Halis Akalin
, Lubos Drgona
, Cornelia Lass-Flörl
, Julio García-Rodríguez
, Tihana Bicanic
, Helena Hammarström
, Petr Hamal
, J. rg Steinmann
, Eelco F. J. Meijer

Nina Khanna, Guillaume Desoubeaux, Thomas Longval, Uluhan Sili, Janina Trauth, Matteo Bassetti, P. Lewis White, Avinash Aujayeb, Tadeja Matos, Deniz Akyol, Francois Danion, Katrien Lagrou, Benedict Rogers, Maite Ruiz, Alena Siváková, Malgorzata Mikulska, Michael Samarkos, Ola Blennow, Deborah E. A. Lockhart, Blandine Denis, Birgit Willinger, Karin van Dijk, Ulrike Scharmann, Anna L. Goodman, Jens van Praet, Manjusha Narayanan, Cristina Toscano, Laura Loughlin, Nick Alexander de Jonge, Alba Ruiz-Gaitan, Fanny Lanternier, Juergen Prattes, Emmanuel Roilides, Alida Fe Talento, Aleksandra Barac, Matthias Egger, Maiken Cavling Arendrup, Philipp Koehler, Oliver A. Cornely, Martin Hoenigl^*

^*Corresponding author for this work

Medical University of Graz
Hospital Clinic de Barcelona
University of Cologne
Partner Site Bonn-Cologne
Hacettepe University
Université de Rennes
Manchester University NHS Foundation Trust
University of Manchester
University of Belgrade
State University of Novi Pazar
Hospital Provincial de Ávila
Osmangazi University
Uludag University
Slovak Academy of Sciences
Innsbruck Medical University
University Hospital La Paz
St. George's University of London
University of Gothenburg
Palacký University Olomouc
Paracelsus Medical University
Canisius Wilhelmina Hospital
Radboud University Nijmegen
University of Basel
Centre Hospitalier Régional Universitaire de Tours
Centre Hospitalier de Versailles
Marmara University
Justus Liebig University Giessen
University of Genoa
IRCCS San Martino Polyclinic Hospital
Public Health Wales
Cardiff University
Northumbria Healthcare NHS Trust
University of Ljubljana
Ege University
Les Hôpitaux Universitaires de Strasbourg
KU Leuven
University Hospitals of Leicester NHS Trust
Hospital Universitario Virgen del Rocio
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas
Masaryk University
National and Kapodistrian University of Athens
Karolinska Institutet
NHS Grampian
University of Aberdeen
Université Paris Cité
Medical University of Vienna
Amsterdam UMC
University of Duisburg-Essen
Guy's and St Thomas' NHS Foundation Trust
University College London
Newcastle upon Tyne Hospitals NHS Foundation Trust
Hospital São José
Belfast Health and Social Care Trust
Hospital Universitario La Fe
Paris Cité University
Aristotle University of Thessaloniki
Trinity College Dublin
Children’s Health Ireland
Royal College of Surgeons in Ireland
Clinical Center of Serbia
Statens Serum Institut
University of Copenhagen
BioTechMed-Graz

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

The European Confederation of Medical Mycology Candida III was a pan-European, multicenter observational study of adult patients with blood culture–proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a subanalysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU patients, non-ICU patients had a higher comorbidity burden (median Charlson comorbidity index [CCI] 6 vs 5 in ICU patients, P = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan–Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, P = .003) and the longest hospital stay, even after excluding all cases with a fatal outcome before day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an infectious disease or clinical microbiology consultant, and initial treatment with an echinocandin, respectively, higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher comorbidity rates, non-ICU patients with candidemia had higher survival rates.

Original language	English
Journal	Open Forum Infect. Dis.
Volume	13
Issue number	4
DOIs	https://doi.org/10.1093/ofid/ofag133
Publication status	Published - 1 Apr 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

candidemia
disease outcome
invasive fungal infections
non-ICU

Access to Document

10.1093/ofid/ofag133

Cite this

Wolfgruber, S., Garcia-Vidal, C., Sedik, S., Salmanton-García, J., Arikan-Akdagli, S., Gangneux, J.-P., Rautemaa-Richardson, R., Arsić-Arsenijević, V., Martín-Pérez, S., Dávila-Valls, J., Erben, N., Akalin, E. H., Drgona, L., Lass-Flörl, C., García-Rodríguez, J., Bicanic, T., Hammarström, H., Hamal, P., Steinmann, J. R., ... Hoenigl, M. (2026). Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study. Open Forum Infect. Dis., 13(4). https://doi.org/10.1093/ofid/ofag133

@article{ce38a536a54f49b0a02788fd5784aa22,

title = "Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study",

abstract = "The European Confederation of Medical Mycology Candida III was a pan-European, multicenter observational study of adult patients with blood culture–proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a subanalysis of 396 (63\%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU patients, non-ICU patients had a higher comorbidity burden (median Charlson comorbidity index [CCI] 6 vs 5 in ICU patients, P = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5\% vs 28.4\%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan–Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3\%, P = .003) and the longest hospital stay, even after excluding all cases with a fatal outcome before day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an infectious disease or clinical microbiology consultant, and initial treatment with an echinocandin, respectively, higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher comorbidity rates, non-ICU patients with candidemia had higher survival rates.",

keywords = "candidemia, disease outcome, invasive fungal infections, non-ICU",

author = "Stella Wolfgruber and Carolina Garcia-Vidal and Sarah Sedik and Jon Salmanton-Garc{\'i}a and Sevtap Arikan-Akdagli and Jean-Pierre Gangneux and Riina Rautemaa-Richardson and Valentina Arsi{\'c}-Arsenijevi{\'c} and Sonia Mart{\'i}n-P{\'e}rez and Julio D{\'a}vila-Valls and Nurettin Erben and Akalin, \{Emin Halis\} and Lubos Drgona and Cornelia Lass-Fl{\"o}rl and Julio Garc{\'i}a-Rodr{\'i}guez and Tihana Bicanic and Helena Hammarstr{\"o}m and Petr Hamal and Steinmann, \{J. rg\} and Meijer, \{Eelco F. J.\} and Nina Khanna and Guillaume Desoubeaux and Thomas Longval and Uluhan Sili and Janina Trauth and Matteo Bassetti and White, \{P. Lewis\} and Avinash Aujayeb and Tadeja Matos and Deniz Akyol and Francois Danion and Katrien Lagrou and Benedict Rogers and Maite Ruiz and Alena Siv{\'a}kov{\'a} and Malgorzata Mikulska and Michael Samarkos and Ola Blennow and Lockhart, \{Deborah E. A.\} and Blandine Denis and Birgit Willinger and \{van Dijk\}, Karin and Ulrike Scharmann and Goodman, \{Anna L.\} and \{van Praet\}, Jens and Manjusha Narayanan and Cristina Toscano and Laura Loughlin and \{de Jonge\}, \{Nick Alexander\} and Alba Ruiz-Gaitan and Fanny Lanternier and Juergen Prattes and Emmanuel Roilides and Talento, \{Alida Fe\} and Aleksandra Barac and Matthias Egger and Arendrup, \{Maiken Cavling\} and Philipp Koehler and Cornely, \{Oliver A.\} and Martin Hoenigl",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America.",

year = "2026",

month = apr,

day = "1",

doi = "10.1093/ofid/ofag133",

language = "English",

volume = "13",

journal = "Open Forum Infect. Dis.",

issn = "2328-8957",

publisher = "Oxford University Press",

number = "4",

}

Wolfgruber, S, Garcia-Vidal, C, Sedik, S, Salmanton-García, J, Arikan-Akdagli, S, Gangneux, J-P, Rautemaa-Richardson, R, Arsić-Arsenijević, V, Martín-Pérez, S, Dávila-Valls, J, Erben, N, Akalin, EH, Drgona, L, Lass-Flörl, C, García-Rodríguez, J, Bicanic, T, Hammarström, H, Hamal, P, Steinmann, JR, Meijer, EFJ, Khanna, N, Desoubeaux, G, Longval, T, Sili, U, Trauth, J, Bassetti, M, White, PL, Aujayeb, A, Matos, T, Akyol, D, Danion, F, Lagrou, K, Rogers, B, Ruiz, M, Siváková, A, Mikulska, M, Samarkos, M, Blennow, O, Lockhart, DEA, Denis, B, Willinger, B, van Dijk, K, Scharmann, U, Goodman, AL, van Praet, J, Narayanan, M, Toscano, C, Loughlin, L, de Jonge, NA, Ruiz-Gaitan, A, Lanternier, F, Prattes, J, Roilides, E, Talento, AF, Barac, A, Egger, M, Arendrup, MC, Koehler, P, Cornely, OA & Hoenigl, M 2026, 'Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study', Open Forum Infect. Dis., vol. 13, no. 4. https://doi.org/10.1093/ofid/ofag133

Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study. / Wolfgruber, Stella; Garcia-Vidal, Carolina; Sedik, Sarah et al.
In: Open Forum Infect. Dis., Vol. 13, No. 4, 01.04.2026.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia

T2 - Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study

AU - Wolfgruber, Stella

AU - Garcia-Vidal, Carolina

AU - Sedik, Sarah

AU - Salmanton-García, Jon

AU - Arikan-Akdagli, Sevtap

AU - Gangneux, Jean-Pierre

AU - Rautemaa-Richardson, Riina

AU - Arsić-Arsenijević, Valentina

AU - Martín-Pérez, Sonia

AU - Dávila-Valls, Julio

AU - Erben, Nurettin

AU - Akalin, Emin Halis

AU - Drgona, Lubos

AU - Lass-Flörl, Cornelia

AU - García-Rodríguez, Julio

AU - Bicanic, Tihana

AU - Hammarström, Helena

AU - Hamal, Petr

AU - Steinmann, J. rg

AU - Meijer, Eelco F. J.

AU - Khanna, Nina

AU - Desoubeaux, Guillaume

AU - Longval, Thomas

AU - Sili, Uluhan

AU - Trauth, Janina

AU - Bassetti, Matteo

AU - White, P. Lewis

AU - Aujayeb, Avinash

AU - Matos, Tadeja

AU - Akyol, Deniz

AU - Danion, Francois

AU - Lagrou, Katrien

AU - Rogers, Benedict

AU - Ruiz, Maite

AU - Siváková, Alena

AU - Mikulska, Malgorzata

AU - Samarkos, Michael

AU - Blennow, Ola

AU - Lockhart, Deborah E. A.

AU - Denis, Blandine

AU - Willinger, Birgit

AU - van Dijk, Karin

AU - Scharmann, Ulrike

AU - Goodman, Anna L.

AU - van Praet, Jens

AU - Narayanan, Manjusha

AU - Toscano, Cristina

AU - Loughlin, Laura

AU - de Jonge, Nick Alexander

AU - Ruiz-Gaitan, Alba

AU - Lanternier, Fanny

AU - Prattes, Juergen

AU - Roilides, Emmanuel

AU - Talento, Alida Fe

AU - Barac, Aleksandra

AU - Egger, Matthias

AU - Arendrup, Maiken Cavling

AU - Koehler, Philipp

AU - Cornely, Oliver A.

AU - Hoenigl, Martin

PY - 2026/4/1

Y1 - 2026/4/1

N2 - The European Confederation of Medical Mycology Candida III was a pan-European, multicenter observational study of adult patients with blood culture–proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a subanalysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU patients, non-ICU patients had a higher comorbidity burden (median Charlson comorbidity index [CCI] 6 vs 5 in ICU patients, P = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan–Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, P = .003) and the longest hospital stay, even after excluding all cases with a fatal outcome before day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an infectious disease or clinical microbiology consultant, and initial treatment with an echinocandin, respectively, higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher comorbidity rates, non-ICU patients with candidemia had higher survival rates.

AB - The European Confederation of Medical Mycology Candida III was a pan-European, multicenter observational study of adult patients with blood culture–proven candidemia. Among a total of 632 patients with candidemia across 64 institutions in 20 European countries, a subanalysis of 396 (63%) cases occurring outside the intensive care unit (ICU) was conducted. Compared with ICU patients, non-ICU patients had a higher comorbidity burden (median Charlson comorbidity index [CCI] 6 vs 5 in ICU patients, P = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, P < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (P < .001). Non-ICU patients had significantly lower mortality in Kaplan–Meier survival analysis (P > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, P = .003) and the longest hospital stay, even after excluding all cases with a fatal outcome before day 30. In non-ICU patients, older age, hemato-oncologic malignancies, chronic liver disease, and COVID-19 were all independently associated with mortality risk, while treatment consultation by an infectious disease or clinical microbiology consultant, and initial treatment with an echinocandin, respectively, higher EQUAL Candida scores were associated with lower mortality risk in the multivariable Cox regression models. In conclusion, despite higher comorbidity rates, non-ICU patients with candidemia had higher survival rates.

KW - candidemia

KW - disease outcome

KW - invasive fungal infections

KW - non-ICU

UR - https://www.scopus.com/pages/publications/105040660836

U2 - 10.1093/ofid/ofag133

DO - 10.1093/ofid/ofag133

M3 - Article

C2 - 41918958

SN - 2328-8957

VL - 13

JO - Open Forum Infect. Dis.

JF - Open Forum Infect. Dis.

IS - 4

ER -

Clinical Characteristics, Management and Outcomes of Nonintensive Care Unit Candidemia: Subanalysis of the ECMM Candida III Multinational European Observational Cohort Study

Abstract

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Keywords

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