Sprute et al reported the EQUAL Trichosporon quality score for 2022. EQUAL reflects the European QUALity measures that reflect adherence to treatment guidelines. The authors are from multiple institutions in Germany and Australia.
Patient selection: Trichosporon infection
Sections:
(1) diagnosis
(2) treatment
(3) follow-up
|
Diagnosis |
Finding |
Points |
|
imaging includes CNS |
no |
0 |
|
|
yes |
2 |
|
ID and/or mycological reference lab consultation |
no |
0 |
|
|
yes |
3 |
|
direct microscopy of clinical specimens including Gram stain |
no |
0 |
|
|
yes |
3 |
|
culture from blood, other sterile fluid or tissue AND urease test |
no |
0 |
|
|
yes |
3 |
|
identification to species level by PCR |
no |
0 |
|
|
yes |
3 |
|
identification to species level by MALDI-TOF MS |
no |
0 |
|
|
yes |
2 |
|
antifungal susceptibility testing |
no |
0 |
|
|
yes |
2 |
|
if organ involvement: histopathology of affected tissue using fungal stains |
no |
0 |
|
|
yes |
3 |
maximum subscore without organ involvement: 18
maximum subscore with organ involvement: 21
|
Treatment |
Finding |
Points |
|
immediate treatment initiation |
no |
0 |
|
|
yes |
2 |
|
consider source control (remove catheter, etc) |
no |
0 |
|
|
yes |
2 |
|
triazole monotherapy (voriconazole; use posaconazole if breakthrough on voriconazole) |
no |
0 |
|
|
yes |
3 |
|
echinocandin monotherapy |
no |
0 |
|
|
yes |
-1 |
|
therapeutic drug monitoring if using azole |
no |
0 |
|
|
yes |
1 |
|
2 week therapy for fungemia; >= 4 week therapy for organ involvement |
no |
0 |
|
|
yes |
2 |
|
if organ involvement: surgical debridement |
no |
0 |
|
|
yes |
2 |
|
if second line therapy needed for uncontrolled disease: concomitant therapy with triazole and polyene |
no |
0 |
|
|
yes |
1 |
maximum subscore without second line therapy and without organ involvement: 10
maximum subscore without second line therapy and with organ involvement: 12
maximum subscore with second line therapy and without organ involvement: 11
maximum subscore with second line therapy and with organ involvement: 13
|
Follow-Up |
Finding |
Points |
|
blood cultures until negative on 3 consecutive days |
no |
0 |
|
|
yes |
3 |
|
if organ involvement then imaging performed weekly in acute disease and monthly in chronic disease |
no |
0 |
|
|
yes |
2 |
maximum subscore without organ involvement: 3
maximum subscore with organ involvement: 5
total score =
= SUM(points for diagnosis, management and follow-up)
Interpretation:
• minimum score: 0
• maximum score without second line therapy and without organ involvement: 31
• maximum score without second line therapy and with organ involvement: 38
• maximum score with second line therapy and without organ involvement: 32
• maximum score with second line therapy and with organ involvement: 39
• The maximum score for an individual patient may be affected by non-applicable items.
