Antifungal tolerance, resistance and clinical outcomes on candidemia caused by non-albicans Candida 

ECMM Candida IV

Antifungal tolerance, resistance and clinical outcomes on candidemia caused by non-albicans Candida 

Observation periods/Timeline
Observation period: April 1^st, 2024 – September 30^th, 2025
Database closure December 31^st 2025
First manuscript with main outcomes submitted for publication March 31^st, 2026

The ECMM (European Confederation of Medical Mycology) conducts international studies on invasive candidiasis (IC) at regular 5- to 10-year intervals. In continuation of this tradition, the fourth multicenter ECMM study was started in April 2024, focusing on candidemia caused by non-albicans Candida species. The aim is to investigate antifungal resistance and tolerance, and their association with clinical outcomes in institutions across the globe. The study is titled:
“Antifungal tolerance, resistance and clinical outcomes in candidemia caused by non-albicans Candida.” It was developed by ECMM President Prof. Martin Hoenigl (Principal Investigator) in collaboration with immediate past ECMM President Prof. Oliver Cornely (Co-Principal Investigator). The study also evaluates the activity of novel antifungals in late-stage clinical development to assess whether they can overcome the challenges posed by these pathogens. With a strong translational focus, the project links clinical data and patient outcomes with findings from basic mycology laboratories, particularly regarding the impact of antifungal tolerance on a large scale.

The observation period runs from April 1^st, 2024 to September 30^th, 2025. Data on the clinical course, treatment, and outcomes will be entered into the ECMM Candida IV EDC System (Carelane). The database will close three months after the end of the observation period. All data entries must be completed in the electronic case report form (eCRF) by December 31^st, 2025.

Eligible are adult patients with candidemia due to non-albicans Candida species, defined according to ECMM/ESCMID criteria (i.e. at least one positive blood culture) (1, 2). Participating centers are expected to include all cases occurring between April 1^st, 2024 and September 30^th, 2025. Patients will be excluded if the fungal isolate responsible for the candidemia is no longer available.

Participation involves the submission of:

• Clinical and microbiological data for the eCRF
• Isolates of non-albicans Candida spp. (not required for Candida auris)

• All isolates should be stored locally and shipped in a single batch at the end of the study. A case-based reimbursement of 100 EUR per isolate and completed eCRF will be provided.

Candida isolates of cases are collected by the ECMM in central repositories under supervision of:

• Maiken Arendrup (maca@ssi.dk) /Conny Lass-Floerl (cornelia.lass-floerl@i-med.ac.at) for isolates collected from participating institutions in Europe
• Sevtap Arikan-Akdagli (sarikanakdagli@gmail.com) for isolates collected from participating institutions in Turkey
• Anuradha Chowdhary (chowdhary.anuradha@gmail.com) for isolates collected from participating institutions in Asia
• Wenjie Fang (fangwenjie1990@126.com; Shanghai Key Laboratory of Molecular Medical Mycology Shanghai Changzheng Hospital) for isolates collected from participating institutions in China
• Sharon Chen (Sharon.Chen@health.nsw.gov.au) for isolates collected from participating institutions in Australia/Oceania
• Gustavo Goldman (ggoldman@usp.br)/Arnaldo Colombo (arnaldolcolombo@gmail.com.br) for isolates collected from participating institutions in Latin America
• Rita Oladele (roladele@unilag.edu.ng) for isolates collected from participating institutions in Africa
• Peter Pappas (ppappas@uabmc.edu) for isolates collected from participating institutions in North American participants

News on the study are regularly posted via the dedicated social media accounts:

• X: https://x.com/ecmmcandidaiv?s=11
• Bluesky: https://bsky.app/profile/ecmmcandidaiv.bsky.social
• LinkedIn: www.linkedin.com/in/ecmm-candida-iv-ecmm-candida-iv-61093935a

If you are interested in participating or would like more information, please get in touch:

📧 Stella Wolfgruber – stella.wolfgruber@medunigraz.at
📧 Sarah Sedik – sarah.sedik@medunigraz.at

This study builds upon the success of ECMM Candida III, conducted from July 2018 to March 2022, which resulted in several high-impact publications, including:

• Koehler P et al. European Confederation of Medical Mycology (ECMM). ECMM CandiReg-A ready to use platform for outbreaks and epidemiological studies. Mycoses. 2019 Oct;62(10):920-927. doi: 10.1111/myc.12963. Epub 2019 Aug 1. PMID: 31271702; PMCID: PMC7614793.
• Hoenigl M, et al. Guideline adherence and survival of patients with candidaemia in Europe: results from the ECMM Candida III multinational European observational cohort study. Lancet Infect Dis. 2023; 23(6):751–761. [PMID: 37254300]
• Arendrup MC, et al. European candidaemia is characterised by notable differential epidemiology and susceptibility pattern: Results from the ECMM Candida III study. J Infect. 2023; 87(5):428–437. [PMID: 37549695]
• Egger M, et al. ECMM Candida III Study Group$. Predictors for Prolonged Hospital Stay Solely to Complete Intravenous Antifungal Treatment in Patients with Candidemia: Results from the ECMM Candida III Multinational European Observational Cohort Study. Mycopathologia. 2023 Dec;188(6):983-994. doi: 10.1007/s11046-023-00776-4. Epub 2023 Aug 11. PMID: 37566212; PMCID: PMC10687104.
• Salmanton-García J, et al. Attributable mortality of candidemia – Results from the ECMM Candida III multinational European Observational Cohort Study. J Infect. 2024; 89(3):106229. [PMID: 39025408]
• Wolfgruber, et al. Insights from Three Pan-European Multicentre Studies on Invasive Candida Infections and Outlook to ECMM Candida IV. Mycopathologia, 189(4), 70. https://doi.org/10.1007/s11046-024-00871-0

We look forward to your interest and collaboration in this global initiative.

References:

1. Cornely OA, Bassetti M, Calandra T, Garbino J, Kullberg BJ, Lortholary O, et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012;18 Suppl 7:19-37.
2. Cornely OA S, R., Bassetti, M., Chen, S. C.-A., Groll, A. H., Kurzai, O., Ostrosky-Zeichner, L., Rautemaa-Richardson, R., Revathi, G., Santolaya, M. E., White, P. L., Alastruey-Izquierdo, A., Arendrup, M. C., Baddley, J., Barac, A., Ben-Ami, R., Brink, A., Grothe, J., Hochhegger, B., Hoenigl, M., Husain, S., Jabeen, K., Jensen, H. E., Kanj, S. S., Koehler, P., Lass-Flörl, C.-A., Lehrnbecher, T., Lewis, R., Meis, J. F., Nguyen, M. H., Pana, Z. D., Rath, P.-M., Seidel, D., Takazono, T., Vinh, D. C., Afeltra, J., Al-Hatmi, A. M. S., Arastehfar, A., Arikan-Akdagli, S., Bongomin, F., Carlesse, F., Chayakulkeeree, M., Chai, L. Y. A., Chamani-Tabriz, L., Chiller, T. M., Chowdhary, A., Clancy, N., Colombo, A., Cortegiani, A., Corzo-León, D. E., Drgoňa, L., Farooqi, J., Gago, S., Guinea, J., Ilkit, M., Jenks, J., Klimko, N., Krause, R., Kumar, A., Lagrou, K., Lionakis, M. S., Lmimouni, B. E., Mansour, M. K., Meletiadis, J., Mellinghoff, S. C., Mer, M., Mikulska, M., Montravers, P., Neoh, C. F., Oezenci, V., Pagano, L., Patterson, T. F., Rahimli, L., Rahn, S., Roilides, E., Rotstein, C., Sabino, R., Salmanton-García, J., Schwartz, I., Segal, E., Siddarthan, N., Singhal, T., Sinko, J., Soman, R., Spec, A., Steinmann, J., Stemler, J., Taj-Aldeen, S J., Talento, A. F., Thompson, G. R., Többen, C., Villanueva, H. E., Wahyuningsih, R., Weinbergerová, B., Wiederhold, N., Willinger, B., Woo, P. C. J., Zhu, L. P. . Global Guideline for the Diagnosis and Management of Candidiasis: An Initiative of the ECMM in Cooperation with ISHAM. 2024.