European confederation of medical mycology quality of clinical candidaemia management score: A review of the points based best practice recommendations

Abstract

Candidaemia is associated with high mortality. In the last few years, several guidelines have been published on the management of Candida bloodstream infection. However, adherence to the practice guidelines has been suboptimal. In order to facilitate and objectively measure the adherence to good practice recommendations, a scoring criterion was published by the European Confederation of Medical Mycology (ECMM). The ECMM Quality (EQUAL) of Clinical Candidaemia Management is an audit tool that comprises of 10 quality indicators. Each quality indicator is allotted between 1 and 3 points. The maximum achievable score is 22 or 19 in patients with or without a central venous catheter, respectively. This paper reviews each of the 10 quality indicators and provides the context for improving quality within the individual domains. The review also suggests areas that are in need of further clarity or areas which merit attention in the future updates of the EQUAL scoring system so that clinicians are able to derive maximum benefit from the audit tool. The EQUAL scoring tool is an important milestone in the quality improvement aspect of the management of candidaemia and contributes to the various components of clinical governance in the management of Candida infection of the bloodstream.

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

“… 25–30 These scores have been validated by several research groups, based on real-life patient data, with reasonable results regarding their correlation with patient outcome. 31–37 …”

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

“…[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. Clinicians may find this tool useful for measuring guideline adherence and adjusting clinical practices as necessary.…”

The interplay of infectious diseases consultation and antimicrobial stewardship in candidemia outcomes: A retrospective cohort study from 2016 to 2019

“…4 The European Confederation of Clinical Mycology QUALity of Clinical Candidemia Management (EQUAL) score measures adherence to European and IDSA guidelines via a weighted quantitative score (Supplementary Table 1 online). [5][6][7][8] Lower EQUAL scores are associated with higher 30-day mortality, although some have not demonstrated mortality differences. [9][10][11][12][13] A Spanish study associated higher EQUAL scores with IDC, and some propose adding IDC to the EQUAL score as a quality measure.…”

“…[9][10][11][12][13] A Spanish study associated higher EQUAL scores with IDC, and some propose adding IDC to the EQUAL score as a quality measure. 6,13 The EQUAL score has not been evaluated in a US cohort.…”