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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.