{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T18:24:30Z","timestamp":1780338270052,"version":"3.54.1"},"reference-count":40,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T00:00:00Z","timestamp":1681344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["FAPESP 2017\/02203-7"],"award-info":[{"award-number":["FAPESP 2017\/02203-7"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["PDSE 88881.187981\/2018-01"],"award-info":[{"award-number":["PDSE 88881.187981\/2018-01"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"name":"CAPES Foundation","award":["FAPESP 2017\/02203-7"],"award-info":[{"award-number":["FAPESP 2017\/02203-7"]}]},{"name":"CAPES Foundation","award":["PDSE 88881.187981\/2018-01"],"award-info":[{"award-number":["PDSE 88881.187981\/2018-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010\u20132011 (Period I) versus 2017\u20132018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities [72 (29.1%) vs. 60 (16.3%), p &lt; 0.001], had a prior history of in-hospital admissions more often [102 (40.3%) vs. 79 (21.4%), p = 0.001], and presented with candidemia earlier after admission, within 15 days (0\u2013328) vs. 19 (0\u2013188), p = 0.01. Echinocandins were more frequently prescribed [102 (41.3%) vs. 50 (13.6%), p = 0.001], but time to antifungal initiation [2 days (0\u201314) vs. 2 (0\u201313), p = 0.369] and CVC removal within 48 h [90\/185 (48.6%) vs. 148\/319 (46.4%), p = 0.644] remained unchanged. Additionally, many patients went untreated in both periods I and II [87 (23.6%) vs. 43 (17.4%), p = 0.07], respectively. Unfortunately, no improvements in mortality rates at 14 days [123 (33.6%) vs. 93 (37.7%), p = 0.343] or at 30 days [188 (51.4%) vs. 120 (48.6%), p = 0.511] were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients\u2019 complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control.<\/jats:p>","DOI":"10.3390\/jof9040468","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T02:03:38Z","timestamp":1681437818000},"page":"468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Prognostic Trends and Current Challenges in Candidemia: A Comparative Analysis of Two Multicenter Cohorts within the Past Decade"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3784-3266","authenticated-orcid":false,"given":"Caroline","family":"Agnelli","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7282-5453","authenticated-orcid":false,"given":"Tha\u00eds","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Hospital do Servidor P\u00fablico Estadual de S\u00e3o Paulo, S\u00e3o Paulo 04039-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Sukiennik","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de Porto Alegre, Rio Grande do Sul 90050-170, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Roberto Passos","family":"Lima","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro Jos\u00e9","family":"Salles","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de S\u00e3o Paulo, S\u00e3o Paulo 01221-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni Lu\u00eds","family":"Breda","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Curitiba; 81531-990, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7034-2418","authenticated-orcid":false,"given":"Flavio","family":"Queiroz-Telles","sequence":"additional","affiliation":[{"name":"Universidade Federal do Paran\u00e1, Curitiba; 81531-990, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello Mihailenko","family":"Chaves Magri","sequence":"additional","affiliation":[{"name":"Hospital das Cl\u00ednicas da Faculdade de Medicina USP (FMUSP), S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Verena","family":"Mendes","sequence":"additional","affiliation":[{"name":"Hospital S\u00e3o Rafael, Salvador 41253-190, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Fernando Aranha","family":"Camargo","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein, S\u00e3o Paulo 05652-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Morales","sequence":"additional","affiliation":[{"name":"Hospital Erasto Gaertner, S\u00e3o Paulo 81520-060, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane Maria","family":"de Carvalho Hessel Dias","sequence":"additional","affiliation":[{"name":"Hospital Nossa Senhora das Gra\u00e7as, Curitiba 80810-040, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fl\u00e1via","family":"Rossi","sequence":"additional","affiliation":[{"name":"Pathology Department, Laborat\u00f3rio de Microbiologia da Divis\u00e3o de Laborat\u00f3rio Central, Hospital das Cl\u00ednicas da Faculdade de Medicina USP (FMUSP), S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0793-8491","authenticated-orcid":false,"given":"Arnaldo Lopes","family":"Colombo","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de S\u00e3o Paulo, S\u00e3o Paulo 04024-002, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1016\/S1473-3099(17)30304-3","article-title":"Candida and invasive mould diseases in non-neutropenic critically ill patients and patients with haematological cancer","volume":"17","author":"Colombo","year":"2017","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Nucci, M., Queiroz-Telles, F., Alvarado-Matute, T., Tiraboschi, I.N., Cortes, J., Zurita, J., Guzman-Blanco, M., Santolaya, M.E., Thompson, L., and Sifuentes-Osornio, J. (2013). Epidemiology of Candidemia in Latin America: A Laboratory-Based Survey. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0059373"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s00134-014-3603-2","article-title":"Incidence, characteristics and outcome of ICU-acquired candidemia in India","volume":"41","author":"Chakrabarti","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1128\/CMR.00029-06","article-title":"Epidemiology of Invasive Candidiasis: A Persistent Public Health Problem","volume":"20","author":"Pfaller","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1007\/s00134-014-3400-y","article-title":"Prognostic factors and historical trends in the epidemiology of candidemia in critically ill patients: An analysis of five multicenter studies sequentially conducted over a 9-year period","volume":"40","author":"Colombo","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Kaur, H., and Chakrabarti, A. (2017). Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries. J. Fungi, 3.","DOI":"10.3390\/jof3030041"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e442","DOI":"10.1016\/j.ijid.2012.02.005","article-title":"Epidemiology and predictors of a poor outcome in elderly patients with candidemia","volume":"16","author":"Nucci","year":"2012","journal-title":"Int. J. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2816","DOI":"10.1128\/JCM.00773-06","article-title":"Epidemiology of Candidemia in Brazil: A Nationwide Sentinel Surveillance of Candidemia in Eleven Medical Centers","volume":"44","author":"Colombo","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Doi, A.M., Pignatari, A.C.C., Edmond, M., Marra, A.R., Camargo, L.F.A., Siqueira, R.A., Da Mota, V.P., and Colombo, A.L. (2016). Epidemiology and Microbiologic Characterization of Nosocomial Candidemia from a Brazilian National Surveillance Program. Chowdhary A, ed. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0146909"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"101041","DOI":"10.1016\/j.bjid.2020.11.006","article-title":"Clinical and epidemiological aspects of Candidemia in eight medical centers in the state of Parana, Brazil: Parana Candidemia Network","volume":"25","author":"Colombo","year":"2021","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.bjid.2018.07.008","article-title":"Secular trends of candidemia at a Brazilian tertiary care teaching hospital","volume":"22","author":"Braga","year":"2018","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.bjid.2013.02.001","article-title":"Brazilian guidelines for the management of candidiasis\u2014A joint meeting report of three medical societies: Sociedade Brasileira de Infectologia, Sociedade Paulista de Infectologia and Sociedade Brasileira de Medicina Tropical","volume":"17","author":"Colombo","year":"2013","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/1469-0691.12039","article-title":"ESCMID* guideline was presented in part at ECCMID 2011. European Society for Clinical Microbiology and Infectious Diseases. guideline for the diagnosis and management of Candida diseases 2012: Non-neutropenic adult patients","volume":"18","author":"Cornely","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s12281-010-0039-1","article-title":"Persistent Candidemia: Causes and Investigations","volume":"5","author":"Nucci","year":"2011","journal-title":"Curr. Fungal Infect. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1128\/JCM.00131-07","article-title":"Biofilm production by Candida species and inadequate antifungal therapy as predictors of mortality for patients with candidemia","volume":"45","author":"Tumbarello","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1007\/s00134-014-3310-z","article-title":"A multicenter study of septic shock due to candidemia: Outcomes and predictors of mortality","volume":"40","author":"Bassetti","year":"2014","journal-title":"Intensive Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bassetti, M., Merelli, M., Ansaldi, F., de Florentiis, D., Sartor, A., Scarparo, C., Callegari, A., and Righi, E. (2015). Clinical and therapeutic aspects of candidemia: A five year single centre study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0127534"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/jac\/dks347","article-title":"Impact on hospital mortality of catheter removal and adequate antifungal therapy in Candida spp. bloodstream infections","volume":"68","year":"2013","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1086\/504810","article-title":"Time to Initiation of Fluconazole Therapy Impacts Mortality in Patients with Candidemia: A Multi-Institutional Study","volume":"43","author":"Garey","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1097\/CCM.0000000000000221","article-title":"Impact of therapeutic strategies on the prognosis of candidemia in the ICU","volume":"42","author":"Zaragoza","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_22","first-page":"100117","article-title":"Prognostic factors of Candida spp. bloodstream infection in adults: A nine-year retrospective cohort study across tertiary hospitals in Brazil and Spain","volume":"6","author":"Agnelli","year":"2022","journal-title":"Lancet Reg. Heal. Am."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1111\/myc.12644","article-title":"The Pitt Bacteremia Score, Charlson Comorbidity Index and Chronic Disease Score are useful tools for the prediction of mortality in patients with Candida bloodstream infection","volume":"60","author":"Ragozzino","year":"2017","journal-title":"Mycoses"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1111\/myc.13376","article-title":"Increasing morbidity and mortality of candidemia over one decade in a Swiss university hospital","volume":"64","author":"Battistolo","year":"2021","journal-title":"Mycoses"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"ofac383","DOI":"10.1093\/ofid\/ofac383","article-title":"\u039aey Role of Early Source Control in Candidemic Patients With Sepsis or Septic Shock","volume":"9","author":"Battistolo","year":"2022","journal-title":"Open Forum Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1111\/myc.13177","article-title":"Attributable mortality of candidemia after introduction of echinocandins","volume":"63","author":"Cornely","year":"2020","journal-title":"Mycoses"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1093\/cid\/cis021","article-title":"Impact of treatment strategy on outcomes in patients with candidemia and other forms of invasive candidiasis: A patient-level quantitative review of randomized trials","volume":"54","author":"Andes","year":"2012","journal-title":"Clin. Infect. Dis."},{"key":"ref_28","first-page":"9","article-title":"ESCMID* guideline was presented in part at ECCMID 2011. European Society for Clinical Microbiology and Infectious Diseases. guideline for the diagnosis and management of Candida diseases 2012: Diagnostic procedures","volume":"18","author":"Verweij","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1093\/cid\/ciac004","article-title":"Attributable Mortality of Candida Bloodstream Infections in the Modern Era: A Propensity Score Analysis","volume":"75","author":"Mazi","year":"2022","journal-title":"Clin. Infect. Dis."},{"key":"ref_30","first-page":"1","article-title":"Nosocomial Candidiasis: Antifungal Stewardship and the Importance of Rapid Diagnosis","volume":"54","author":"Pfaller","year":"2016","journal-title":"Med. Mycol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e01909-17","DOI":"10.1128\/JCM.01909-17","article-title":"Diagnosing Invasive Candidiasis","volume":"56","author":"Clancy","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.ijantimicag.2012.07.018","article-title":"Efficacy and safety of anidulafungin in elderly, critically ill patients with invasive Candida infections: A post hoc analysis","volume":"40","author":"Dimopoulos","year":"2012","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1093\/jac\/dkt256","article-title":"Clinical impact of time to positivity for Candida species on mortality in patients with candidaemia","volume":"68","author":"Kim","year":"2013","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/myc.12329","article-title":"Antifungal stewardship in daily practice and health economic implications","volume":"58","author":"Valerio","year":"2015","journal-title":"Mycoses"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"492.e1","DOI":"10.1016\/j.cmi.2015.01.013","article-title":"Antifungal stewardship in a tertiary-care institution: A bedside intervention","volume":"21","author":"Valerio","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13756-018-0388-z","article-title":"Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant gram-negative bacteria colonization or infection","volume":"7","author":"Tseng","year":"2018","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.cmi.2019.04.024","article-title":"Morbidity and mortality of candidaemia in Europe: An epidemiologic meta-analysis","volume":"25","author":"Koehler","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ejim.2016.08.020","article-title":"Epidemiology and outcome of candidemia in internal medicine wards: A regional study in Italy","volume":"34","author":"Tedeschi","year":"2016","journal-title":"Eur. J. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1159\/000510638","article-title":"Clinical Features and Mortality of Nosocomial Candidemia in Very Old Patients: A Multicentre Italian Study","volume":"66","author":"Zatta","year":"2020","journal-title":"Gerontology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s11046-022-00624-x","article-title":"Candidemia in Internal Medicine: Facing the New Challenge","volume":"187","author":"Brescini","year":"2022","journal-title":"Mycopathologia"}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/4\/468\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:15:41Z","timestamp":1760123741000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/4\/468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,13]]},"references-count":40,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jof9040468"],"URL":"https:\/\/doi.org\/10.3390\/jof9040468","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,13]]}}}