Is candidemia mortality inevitable or a consequence of inadequate guideline adherence?

Candidemia is a severe healthcare-associated infection with persistently high mortality, particularly in critically ill patients. Beyond host severity, inadequate implementation of recommended management strategies may substantially influence outcomes.

This retrospective observational study included adult patients with at least one episode of candidemia in a Brazilian tertiary hospital between 2018 and 2024. Clinical, microbiological, and therapeutic variables were analyzed, including adherence to an eight-item candidemia care bundle. In-hospital mortality was the primary outcome. Univariate, multivariate logistic regression, and Kaplan-Meier survival analyses were performed.

Among 136 patients (mean age 62.4-years), 87.5% required ICU admission. Overall mortality reached 76.5%. Candida albicans (32.4%) and the C. parapsilosis complex (29.4%) were the most frequent species. Non-optimal treatment (OR = 5.52; p = 0.031) and failure to remove the central venous catheter (OR = 6.60; p = 0.004) were independent predictors of death. Catheter removal significantly improved survival (p < 0.001). Survivors showed greater adherence to the care bundle (3.66 vs. 1.98 items; p = 0.001) and more frequent Infectious Diseases consultation (50%vs. 28.8%; p = 0.027). Mortality did not differ between catheter-drawn and peripheral blood cultures.

In this cohort, candidemia mortality was strongly associated with failure in early vascular source control and poor adherence to recommended management, underscoring quality of care as a key determinant of survival.