Application of the EQUAL Candida Score to assess guideline adherence and predict mortality in patients with candidemia: a retrospective cohort study from Vietnam

Objectives To evaluate guideline adherence using the EQUAL Candida Score and its prognostic value for mortality in patients with candidemia at a Vietnamese tertiary hospital. Methods Single-centre retrospective cohort study of 196 consecutive patients with culture-confirmed candidemia at Bach Mai Hospital, Hanoi, Vietnam (June 2019 to June 2022). The EQUAL Candida Score was calculated from medical records. All-cause mortality (including moribund discharge for end-of-life care) was modelled with logistic and Cox regression using pre-specified covariate adjustment, with treated-only, monomicrobial-only, and quartile-based sensitivity analyses. Results All-cause mortality was 51.5%. Mean EQUAL score was 7.2 ± 2.8 (33.7% of maximum). Blood culture volume and daily follow-up cultures had 0% adherence; echinocandin initial therapy was 27.6%. The EQUAL score independently predicted mortality (adjusted HR 0.812 per point, 95% CI 0.740–0.892, p < 0.001). Combined EQUAL+SOFA achieved AUC 0.806 (95% CI 0.745–0.864). Landmark analysis confirmed robustness (HR 0.873, p = 0.016). Of 83 untreated patients (42.4%), the early departure group had 80.0% mortality. Conclusions Guideline adherence was low in this Vietnamese cohort, yet the EQUAL score retained independent prognostic value. Targeted antifungal stewardship focusing on echinocandin access and blood culture practices may improve outcomes.