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QCI	Definition	Formula	Reference no. Supplementary data
Initial treatment
(a) Early adequate antifungal therapy	Within first 72 h after positive blood culture.	Adequate intravenous antifungal therapy (within 72 h) × 100/patients alive at 48 h.	1–48
(b) Initial treatment with echinocandins if septic shock	Initial treatment with echinocandins in patients with septic shock or severely ill patients in ICU.	Initial therapy (first 48 h) with echinocandins × 100/septic shock or severely ill patients in ICU patients alive at 48 h.	6, 42, 49–54
(c) Early source control	Drainage of abscess within 72 h of positive blood culture or CVC removal.	Patients with early source control (<72 h) × 100/patients with a source suitable for drainage or CVC removal.	6, 10–12, 15, 21, 32–34, 36, 37, 39, 51, 55–70
Identification of complicated candidaemia
(a) Follow-up blood culture	Perform blood cultures every 48 h after starting antifungal therapy and until clearance of candidaemia.	Patients with follow-up blood culture (after 48 h of treatment) × 100/patients alive at 48 h.	16, 36, 38, 58, 71–74
(b) Ophthalmoscopic evaluation	Ophthalmoscopic evaluation in every patient.	Patients in whom an ophthalmoscopic evaluation was performed × 100/patients.	75–77
(c) Echocardiography	Performance of echocardiography in patients with complicated candidaemia or cardiological risk factor for endocarditis.	Patients in whom echocardiography was performed × 100/patients with complicated candidaemia or cardiological risk factors for endocarditis (alive at least at 96 h).	78, 79
Treatment adequacy
(a) De-escalate therapy	De-escalation antifungal therapy.	De-escalation antifungal therapy × 100/patients with an isolated species susceptible to de-escalation antifungal therapy within 3 days.	80–83
(b) Adequate length of antifungal treatment	At least 14 days of treatment since last positive blood culture in uncomplicated candidaemia (or more as required by complicated candidaemia).	Patients with correct length of treatment × 100/patients alive at 14 days (28 days in complicated candidaemia).	84–94

QCI

Definition

Formula

Reference no. Supplementary data

Initial treatment

(a) Early adequate antifungal therapy

Within first 72 h after positive blood culture.

Adequate intravenous antifungal therapy (within 72 h) × 100/patients alive at 48 h.

1–48

(b) Initial treatment with echinocandins if septic shock

Initial treatment with echinocandins in patients with septic shock or severely ill patients in ICU.

Initial therapy (first 48 h) with echinocandins × 100/septic shock or severely ill patients in ICU patients alive at 48 h.

6, 42, 49–54

Drainage of abscess within 72 h of positive blood culture or CVC removal.

Patients with early source control (<72 h) × 100/patients with a source suitable for drainage or CVC removal.

6, 10–12, 15, 21, 32–34, 36, 37, 39, 51, 55–70

Identification of complicated candidaemia

(a) Follow-up blood culture

Perform blood cultures every 48 h after starting antifungal therapy and until clearance of candidaemia.

Patients with follow-up blood culture (after 48 h of treatment) × 100/patients alive at 48 h.

16, 36, 38, 58, 71–74

(b) Ophthalmoscopic evaluation

Ophthalmoscopic evaluation in every patient.

Patients in whom an ophthalmoscopic evaluation was performed × 100/patients.

75–77

Performance of echocardiography in patients with complicated candidaemia or cardiological risk factor for endocarditis.

Patients in whom echocardiography was performed × 100/patients with complicated candidaemia or cardiological risk factors for endocarditis (alive at least at 96 h).

78, 79

Treatment adequacy

(a) De-escalate therapy

De-escalation antifungal therapy.

De-escalation antifungal therapy × 100/patients with an isolated species susceptible to de-escalation antifungal therapy within 3 days.

80–83

(b) Adequate length of antifungal treatment

At least 14 days of treatment since last positive blood culture in uncomplicated candidaemia (or more as required by complicated candidaemia).

Patients with correct length of treatment × 100/patients alive at 14 days (28 days in complicated candidaemia).

84–94

QCI	Definition	Formula	Reference no. Supplementary data
Initial treatment
(a) Early adequate antifungal therapy	Within first 72 h after positive blood culture.	Adequate intravenous antifungal therapy (within 72 h) × 100/patients alive at 48 h.	1–48
(b) Initial treatment with echinocandins if septic shock	Initial treatment with echinocandins in patients with septic shock or severely ill patients in ICU.	Initial therapy (first 48 h) with echinocandins × 100/septic shock or severely ill patients in ICU patients alive at 48 h.	6, 42, 49–54
(c) Early source control	Drainage of abscess within 72 h of positive blood culture or CVC removal.	Patients with early source control (<72 h) × 100/patients with a source suitable for drainage or CVC removal.	6, 10–12, 15, 21, 32–34, 36, 37, 39, 51, 55–70
Identification of complicated candidaemia
(a) Follow-up blood culture	Perform blood cultures every 48 h after starting antifungal therapy and until clearance of candidaemia.	Patients with follow-up blood culture (after 48 h of treatment) × 100/patients alive at 48 h.	16, 36, 38, 58, 71–74
(b) Ophthalmoscopic evaluation	Ophthalmoscopic evaluation in every patient.	Patients in whom an ophthalmoscopic evaluation was performed × 100/patients.	75–77
(c) Echocardiography	Performance of echocardiography in patients with complicated candidaemia or cardiological risk factor for endocarditis.	Patients in whom echocardiography was performed × 100/patients with complicated candidaemia or cardiological risk factors for endocarditis (alive at least at 96 h).	78, 79
Treatment adequacy
(a) De-escalate therapy	De-escalation antifungal therapy.	De-escalation antifungal therapy × 100/patients with an isolated species susceptible to de-escalation antifungal therapy within 3 days.	80–83
(b) Adequate length of antifungal treatment	At least 14 days of treatment since last positive blood culture in uncomplicated candidaemia (or more as required by complicated candidaemia).	Patients with correct length of treatment × 100/patients alive at 14 days (28 days in complicated candidaemia).	84–94

Table 1.

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Bundle recommendations and definitions of QCIs for candidaemia as selected from literature

QCI	Definition	Formula	Reference no. Supplementary data
Initial treatment
(a) Early adequate antifungal therapy	Within first 72 h after positive blood culture.	Adequate intravenous antifungal therapy (within 72 h) × 100/patients alive at 48 h.	1–48
(b) Initial treatment with echinocandins if septic shock	Initial treatment with echinocandins in patients with septic shock or severely ill patients in ICU.	Initial therapy (first 48 h) with echinocandins × 100/septic shock or severely ill patients in ICU patients alive at 48 h.	6, 42, 49–54
(c) Early source control	Drainage of abscess within 72 h of positive blood culture or CVC removal.	Patients with early source control (<72 h) × 100/patients with a source suitable for drainage or CVC removal.	6, 10–12, 15, 21, 32–34, 36, 37, 39, 51, 55–70
Identification of complicated candidaemia
(a) Follow-up blood culture	Perform blood cultures every 48 h after starting antifungal therapy and until clearance of candidaemia.	Patients with follow-up blood culture (after 48 h of treatment) × 100/patients alive at 48 h.	16, 36, 38, 58, 71–74
(b) Ophthalmoscopic evaluation	Ophthalmoscopic evaluation in every patient.	Patients in whom an ophthalmoscopic evaluation was performed × 100/patients.	75–77
(c) Echocardiography	Performance of echocardiography in patients with complicated candidaemia or cardiological risk factor for endocarditis.	Patients in whom echocardiography was performed × 100/patients with complicated candidaemia or cardiological risk factors for endocarditis (alive at least at 96 h).	78, 79
Treatment adequacy
(a) De-escalate therapy	De-escalation antifungal therapy.	De-escalation antifungal therapy × 100/patients with an isolated species susceptible to de-escalation antifungal therapy within 3 days.	80–83
(b) Adequate length of antifungal treatment	At least 14 days of treatment since last positive blood culture in uncomplicated candidaemia (or more as required by complicated candidaemia).	Patients with correct length of treatment × 100/patients alive at 14 days (28 days in complicated candidaemia).	84–94

QCI	Definition	Formula	Reference no. Supplementary data
Initial treatment
(a) Early adequate antifungal therapy	Within first 72 h after positive blood culture.	Adequate intravenous antifungal therapy (within 72 h) × 100/patients alive at 48 h.	1–48
(b) Initial treatment with echinocandins if septic shock	Initial treatment with echinocandins in patients with septic shock or severely ill patients in ICU.	Initial therapy (first 48 h) with echinocandins × 100/septic shock or severely ill patients in ICU patients alive at 48 h.	6, 42, 49–54
(c) Early source control	Drainage of abscess within 72 h of positive blood culture or CVC removal.	Patients with early source control (<72 h) × 100/patients with a source suitable for drainage or CVC removal.	6, 10–12, 15, 21, 32–34, 36, 37, 39, 51, 55–70
Identification of complicated candidaemia
(a) Follow-up blood culture	Perform blood cultures every 48 h after starting antifungal therapy and until clearance of candidaemia.	Patients with follow-up blood culture (after 48 h of treatment) × 100/patients alive at 48 h.	16, 36, 38, 58, 71–74
(b) Ophthalmoscopic evaluation	Ophthalmoscopic evaluation in every patient.	Patients in whom an ophthalmoscopic evaluation was performed × 100/patients.	75–77
(c) Echocardiography	Performance of echocardiography in patients with complicated candidaemia or cardiological risk factor for endocarditis.	Patients in whom echocardiography was performed × 100/patients with complicated candidaemia or cardiological risk factors for endocarditis (alive at least at 96 h).	78, 79
Treatment adequacy
(a) De-escalate therapy	De-escalation antifungal therapy.	De-escalation antifungal therapy × 100/patients with an isolated species susceptible to de-escalation antifungal therapy within 3 days.	80–83
(b) Adequate length of antifungal treatment	At least 14 days of treatment since last positive blood culture in uncomplicated candidaemia (or more as required by complicated candidaemia).	Patients with correct length of treatment × 100/patients alive at 14 days (28 days in complicated candidaemia).	84–94

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