Candidemia in ICU Patients: What Are the Real Game-Changers for Survival?
Bianca Leal de Almeida | Caroline Agnelli | Thaís Guimarães | Teresa Sukiennik | Paulo Roberto Passos Lima | Mauro José Costa Salles | Giovanni Luís Breda | Flavio Queiroz-Telles | Ana Verena Almeida Mendes | Luís Fernando Aranha Camargo | Hugo Manuel Paz Morales | Viviane Maria de Carvalho Hessel Dias | Afonso Rafael da Silva Junior | João Nóbrega de Almeida Junior | Camila de Melo Picone | Evangelina da Motta Pacheco Alves de Araújo | Edson Abdala | Flávia Rossi | Arnaldo Lopes Colombo | Marcello Mihailenko Chaves Magri
Candidemia infection remains a critical challenge in intensive care units (ICUs), with high morbidity and mortality rates despite advances in therapeutic practices. This multicenter prospective surveillance study assessed the epidemiology, clinical management, and mortality predictors of candidemia in critically ill patients across two periods (2010–2012 and 2017–2018) in 11 tertiary hospitals in Brazil. Among 314 ICU patients with candidemia, the overall mortality rate was 60.2%, with no significant reduction over time (58.8% vs. 62.6%, <i>p</i> = 0.721). <i>Candida albicans</i> was the predominant pathogen (43.6%), followed by <i>C. tropicalis</i> (20%) and <i>C. glabrata</i> (13.7%). The use of echinocandins increased significantly in the second period (21.1% to 41.7%, <i>p</i> < 0.001); however, 70% of patients still did not receive these agents as first-line therapy. Catheter removal due to candidemia was performed in only 52.1% of cases but was associated with improved 30-day survival (<i>p</i> < 0.001). Multivariate analysis identified cancer, inadequate treatment, and vasoactive drug use as independent predictors of mortality. Our findings underscore persistent gaps in adherence to guidelines, particularly regarding timely echinocandin initiation and catheter removal. Strengthening therapeutic strategies focused on these key interventions is essential to improving outcomes for ICU patients with candidemia.
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