CAMEO – a Cross-Sectional Survey Study on Candidemia Management in Germany

Abstract Candida species cause life-threatening bloodstream infections, particularly in critically ill and immunocompromised patients. Although guideline adherence has been shown to improve outcomes, real-world implementation is often constrained. This cross-sectional, web-based survey evaluated current clinical practices and barriers in candidemia management across German healthcare institutions. A structured questionnaire based on the EQUAL Candida score was disseminated online from 10/2023 to 07/2025. Physicians involved in candidemia management reported institutional characteristics, diagnostic practices, antifungal treatment strategies, central line management, and follow-up practices. Data were analyzed using descriptive statistics and chi-square testing. A total of 217 physicians from 147 institutions participated, with 74.5% of participants affiliated with large care facilities. Caspofungin was the predominant first-line therapy (81.4%), whereas fluconazole was used by 5.3% of participants. First-line choice did not differ by years of clinical experience (p = 0.194). Echocardiography was routinely performed by 57% of participants; selective use showed no association with years of clinical experience (p = 0.845) or annual number of candidemia cases (p = 0.089). Ophthalmoscopy was performed routinely by 37% of participants and showed no association with experience (p = 0.907), but was significantly associated with lower annual caseload (p = 0.02) and infectious disease speciality (p = 0.003). Central line removal or replacement within 24 hours was reported by 82.5%. Follow-up blood cultures were obtained daily by 31.4%, while 54.8% repeated cultures every 48 hours. While core candidemia management practices are generally well implemented in German healthcare institutions, certain recommended diagnostic steps remain underutilized. Targeted educational and structural interventions are needed to strengthen guideline adherence and optimize patient outcomes across diverse settings.