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.

The gold standard for diagnosing invasive candidiasis still relies on blood cultures, which are inefficient and time-consuming to analyze. We developed an in-house qPCR assay to identify the 5 major Candida species in 78 peripheral blood (PB) samples from ICU patients at risk of candidemia. Blood cultures and (1,3)-β-D-glucan (BDG) testing were performed concurrently to evaluate the performance of the qPCR. The qPCR was positive for DNA samples from all 20 patients with proven candidemia (positive PB cultures), showing complete concordance with Candida species identification in blood cultures, except for detection of dual candidemia in 4 patients, which was missed by blood cultures. Additionally, the qPCR detected Candida species in six DNA samples from patients with positive central venous catheters blood (CB) but negative PB cultures. BDG values were similarly high in these six samples and the ones with proven candidemia, strongly suggesting the diagnosis of a true candidemia episode despite the negative PB cultures. Samples from patients neither infected nor colonized yielded negative results in both the qPCR and BDG testing. Our qPCR assay was at least as sensitive as blood cultures, but with a shorter turnaround time. Furthermore, negative results from the qPCR provided strong evidence for the absence of candidemia caused by the five major Candida species.

Candida parapsilosis has emerged as a prominent cause of nosocomial candidemia, particularly among critically ill patients. The increasing prevalence of fluconazole-resistant C. parapsilosis (FR-Cp) poses major therapeutic challenges, especially in resource-limited settings. We conducted a retrospective study of 144 patients with C. parapsilosis candidemia admitted to two post-surgical ICUs at a Brazilian tertiary cardiothoracic hospital between 2016 and August 2024. Demographic, clinical, microbiological, and therapeutic data were analyzed. Predictors of 30-day mortality were identified through multivariate logistic regression. The incidence density of C. parapsilosis candidemia ranged from 2.93 to 8.31 per 1000 hospitalizations. Fluconazole resistance was identified in 81% of isolates. Overall 30-day mortality was 55%. Independent risk factors for mortality included cardiopathy (OR: 19.36, p = 0.006), higher SOFA scores (OR: 1.54, p = 0.003), parenteral nutrition (OR: 29.77, p = 0.013), and dialysis (OR: 6.59, p = 0.043), while longer treatment duration was protective (OR: 0.81, p < 0.001). Fluconazole resistance was not independently associated with increased mortality. In this cohort of critically ill patients, C. parapsilosis candidemia was associated with high mortality and a high prevalence of fluconazole resistance. Clinical outcomes were mainly driven by host-related and therapeutic factors rather than antifungal resistance alone.

We report a rare case of disseminated Cryptococcus gattii species complex (CGSC) infection in a 51-year-old immunocompetent man who initially had extensive ulcerated skin nodules, an uncommon cutaneous manifestation of cryptococcosis. Positron emission tomography/computed tomography (PET/CT) revealed hypermetabolic lesions in the skin and lungs, while brain magnetic resonance imaging (MRI) demonstrated multiple cryptococcomas with mass effect. The diagnosis was confirmed by skin and lung biopsies and a positive serum cryptococcal antigen test. Induction therapy with lipid complex amphotericin B, flucytosine, and corticosteroids was initiated. This case highlights the importance of recognizing atypical cutaneous lesions as potential indicators of disseminated CGSC infection in immunocompetent individuals, and underscores the need for early antifungal management.