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

The European Confederation of Medical Mycology <i>Candida</i> 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, <i>P</i> = .006). Hematologic and oncologic malignancies were more frequent among non-ICU cases (45.5% vs 28.4%, <i>P</i> < .001), whereas both chronic kidney and cardiovascular disease were more prevalent in ICU patients (<i>P</i> < .001). Non-ICU patients had significantly lower mortality in Kaplan-Meier survival analysis (<i>P</i> > .001). Postsurgical non-ICU patients (n = 45) had the highest survival rate (73.3%, <i>P</i> = .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 <i>Candida</i> 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.