• Arnaldo L Colombo, Thais Guimarães, Teresa Sukienik, Alessandro C Pasqualotto, Ricardo Andreotti, Flavio Queiroz-Telles, Simone A Nouér, and Marcio Nucci.
• Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil, arnaldolcolombo@gmail.com.
• Intensive Care Med. 2014 Oct 1; 40 (10): 1489-98.

PurposeTo describe temporal trends in the epidemiology, clinical management and outcome of candidemia in intensive care unit (ICU) patients.MethodsThis study was a retrospective analysis of 1,392 episodes of candidemia in 647 adult ICU patients from 22 Brazilian hospitals. The characteristics of candidemia in these ICU patients were compared in two periods (2003-2007, period 1; 2008-2012, period 2), and the predictors of 30-day mortality were assessed.ResultsThe proportion of patients who developed candidemia while in the ICU increased from 44 % in period 1 to 50.9 % in period 2 (p = 0.01). Prior exposure to fluconazole before candidemia (22.3 vs. 11.6 %, p < 0.001) and fungemia due to Candida glabrata (13.1 vs. 7.8 %, p = 0.03) were more frequent in period 2, as was the proportion of patients receiving an echinocandin as primary therapy (18.0 vs. 5.9 %, p < 0.001). The 30-day mortality rate decreased from 76.4 % in period 1 to 60.8 % in period 2 (p < 0.001). Predictors of 30-day mortality by multivariate analysis were older age, period 1, treatment with corticosteroids and higher APACHE II score, while treatment with an echinocandin were associated with a higher probability of survival.ConclusionsWe found a clear change in the epidemiology and clinical management of candidemia in ICU patients over the 9-year period of the study. The use of echinocandins as primary therapy for candidemia appears to be associated with better outcomes.

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