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

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.

EQUAL CPA Score 2022: a tool to measure guideline adherence for chronic pulmonary aspergillosis

“…Equivalent to the other EQUAL scores, this tool was designed as a bedside instrument for selfassessment of management quality and to support antifungal stewardship. [14][15][16][17][18][19][20] One of the main objectives of CPA management is to reliably diagnose or rule out CPA when clinically suspected. A multidisciplinary team conference between healthcare professionals with different medical expertise is crucial for obtaining consensus on the appropriate diagnostic and therapeutic approaches in difficult to manage fungal infections.…”

“…Currently, EQUAL scores are available for candidemia, invasive aspergillosis, cryptococcosis, mucormycosis, fusariosis, Scedosporium-, Lomentospora-and Trichosporon-associated infections. [14][15][16][17][18][19][20] In several subsequent studies, guideline adherence correlated with patient outcome. [21][22][23][24][25][26][27] Here, we present an EQUAL Score weighing recommendations from current guidelines for the management of CPA.…”

Antifungal stewardship in solid organ transplantation

“…3,4,28,58 EQUAL scores are now available for management of the most important fungal infections that implements a variety of guidelines and current best practises into simple score cards, which have been translated into multiple languages. [59][60][61] In addition, these international guidelines could be translated into local guidelines that can be implemented for a standardized approach when IFI is suspected and should always take into account the organ transplanted. 52,57 As mentioned above IFIs are complex infections, which require a lot of expertise on different aspects such as interpretation of diagnostic tests and selection of appropriate antifungal agents.…”

Genotypic diversity and antifungal susceptibility of Scedosporium species from clinical settings in China

“…Moreover, Scedosporium species are often resistant to most currently available antifungals including amphotericin B (AMB), 2 which made treatment against Scedosporium infections very challenging. The recent guidelines strongly recommend voriconazole (VOR) as first‐line antifungal treatment, combined with surgical debridement when possible 16–18 …”

“…The recent guidelines strongly recommend voriconazole (VOR) as first-line antifungal treatment, combined with surgical debridement when possible. [16][17][18] Scedosporium species have drawn significant interests in recent years because of their increasing prevalence in polluted habitats worldwide, 2 often leading high mortality in patients with disseminated infections after near-drowning experiences. 19 In Asian countries such as India, Japan and Malaysia, S. apiospermum is the most common causative agent of the genus, followed by S. boydii, S. aurantiacum and S. dehoogii.…”