Candidemia in ICU Patients: What Are the Real Game-Changers for Survival?

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de Almeida, Bianca Leal ; Agnelli, Caroline ; Guimaraes, Thais ; Sukiennik, Teresa ; Lima, Paulo Roberto Passos ; Salles, Mauro Jose Costa ; Breda, Giovanni Luis ; Queiroz-Telles, Flavio ; Mendes, Ana Verena Almeida ; Camargo, Luis Fernando Aranha ; Morales, Hugo Manuel Paz ; Dias, Viviane Maria de Carvalho Hessel ; da Silva Junior, Afonso Rafael ; de Almeida Junior, Joao Nobrega ; Picone, Camila de Melo ; de Araujo, Evangelina da Motta Pacheco Alves ; Abdala, Edson ; Rossi, Flavia ; Colombo, Arnaldo Lopes ; Magri, Marcello Mihailenko Chaves

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF FUNGI; v. 11, n. 2, p. 12-pg., 2025-02-01.

Resumo

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%, p = 0.721). Candida albicans was the predominant pathogen (43.6%), followed by C. tropicalis (20%) and C. glabrata (13.7%). The use of echinocandins increased significantly in the second period (21.1% to 41.7%, p < 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 (p < 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. (AU)

• Processo FAPESP: 21/10599-3 - Instituto Paulista de Resistência aos Antimicrobianos (Projeto ARIES)
• Beneficiário: Arnaldo Lopes Colombo
• Modalidade de apoio: Auxílio à Pesquisa - Centros de Pesquisa, Inovação e Difusão - CEPIDs