Glabrata Infection Research Articles

Species distribution and in vitro antifungal susceptibility profiles of yeast isolates from invasive infections during a Portuguese multicenter survey.

This is the first Portuguese multicenter observational and descriptive study that provides insights on the species distribution and susceptibility profiles of yeast isolates from fungemia episodes. Ten district hospitals across Portugal contributed by collecting yeast isolates from blood cultures and answering questionnaires concerning patients' data during a 12-month period. Molecular identification of cryptic species of Candida parapsilosis and C. glabrata complex was performed. The susceptibility profile of each isolate, considering eight of the most often used antifungals, was determined. Both Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) protocols were applied. The incidence of 240 episodes of fungemia was 0.88/1,000 admissions. Fifteen different species were found, with C. albicans (40 %) being the most prevalent, followed by C. parapsilosis (23 %) and C. glabrata (13 %). Most isolates were recovered from patients admitted to surgical wards or intensive care units, with 57 % being males and 32 % aged between 41 and 60 years. For both the CLSI and EUCAST protocols, the overall susceptibility rates ranged from 74 to 97 % for echinocandins and from 84 to 98 % for azoles. Important resistance rate discrepancies between protocols were observed in C. albicans and C. glabrata for echinocandins and in C. parapsilosis and C. tropicalis for azoles. Death associated with fungemia occurred in 25 % of the cases, with more than half of C. glabrata infections being fatal. The great number of Candida non-albicans is noteworthy despite a relatively low antifungal resistance rate. Studies like this are essential in order to improve empirical treatment guidelines.

Polymerase Chain Reaction Melting Profiles of Candida glabrata Clinical Isolates in Solid Organ Transplant Recipients in Comparison to the Other Group of Surgical Patients

The aim of the retrospective study were to estimate the prevalence of Candida glabrata in liver and kidney transplant recipients compared to patients with short bowel syndrome receiving chronic total parenteral nutrition and relevance of the polymerase chain reaction melting profile (PCR MP) method for Candida glabrata strains differentiation. C. glabrata clinical strains isolated from patients were identified by using standard mycological procedures. The analysis of genetic relatedness of the isolated strains was conducted using the PCR MP method. The prevalence of C. glabrata comprised 29% of all episodes of fungal colonization and infection in solid organ transplant recipients, and 54% of those in hospitalized patients receiving long-term total parenteral nutrition. Among 78 isolates obtained from 55 solid organ transplant recipients and 2 organ donors, 44 different C. glabrata PCR MP fingerprints were observed. Forty-seven organ recipients and one organ donor carried unique C. glabrata strains. Among 37 isolates obtained from 31 patients receiving long-term TPN, 8 different PCR MP profiles of C. glabrata strains were observed. Two patients carried unique C. glabrata strains. Most of the C. glabrata colonization and infections in solid-organ transplant recipients were caused by endogenic strains. Most of the C. glabrata colonization and infections in hospitalized patients receiving long-term total parenteral nutrition could result by patient-to-patient transmission. The results showed that the PCR MP technique is a good discriminatory method for genotyping for C. glabrata strains.

Candida glabrata and pre-term premature rupture of membrane complicating in vitro pregnancy: case report and confirmation of mother to neonate transmission

We report a case of Candida glabrata infection in an in vitro fertilization-assisted pregnancy complicated by pre-term pre-labor rupture of the membranes. We found C. glabrata in gastric fluid, amniotic fluid and maternal vaginal swab. Neonatal and maternal isolates showed indistinguishable molecular patterns analyzed by fingerprint DNA multilocus. Strong consideration should be given to perform a screening test C. glabrata. Multiple treatments, even in pregnancy, should be considered in women who have positive cultures results.

Virulence Markers and Antifungal Susceptibility Profile of Candida glabrata: An Emerging Pathogen

Aims: To study virulence factors and antifungal susceptibility profile of C. glabrata isolated from various clinical specimens. Study Design: A total of 175 C. glabrata spp. isolated from various clinical specimens were included in the study. Place and Duration of Study: Department of Microbiology, Rural Medical College, Pravara Institute of Medical Sciences (PIMS), Loni, Maharashtra, India, between March 2008 to March 2013. Methodology: C. glabrata was identified by sugar assimilation and fermentation tests and colony color on Hichrome Candida agar. HiCandida identification kit supplemented the identification of the isolates. The virulence markers studied were production of extracellular hydrolytic enzymes (phospholipase, proteinase and coagulase), haemolytic activity and biofilm formation. The antifungal susceptibility profile of C. glabrata isolates was determined by Hicomb minimum inhibitory concentration (MIC) test. The antifungal agents used were amphotericin B (range 0.002-32 μg), fluconazole (range 0.016-256 μg), itraconazole (range 0.002-32 μg) and ketoconazole (range 0.002-32 μg). Results: Maximum number of isolates were obtained from blood culture (36%) followed by urine sample (29.7%). ICU stay followed by HIV infection were the main predisposing factors found to be associated with C. glabrata infection. A total of 53 (30.2%) C. glabrata Research Article British Microbiology Research Journal, 4(1): 39-49, 2014 40 isolates showed phospholipase activity. Proteinase production was seen in 56 (32%) isolates. 48 (27.4%) isolates were coagulase positive. Haemolytic activity was noted in 43 (24.5%) isolates. Most of C. glabrata produced βtype of haemolysis on sheep blood SDA agar. Biofilm forming ability was noted in 68 (38.8%) isolates. Maximum isolates were resistant to fluconazole (46.8%) and ketoconazole (46.8%) followed by itraconazole (45.7%). Amphotericin B resistance was seen in 58 (33.1%) isolates. Conclusion: Once considered as a non pathogenic human commensal, C. glabrata has emerged as an important pathogen in various clinical types of candidiasis. C. glabrata is innately resistant to antifungal drugs and various antifungal mechanisms of the body. Present research data available is not satisfactory to understand the pathogenic and other mechanisms involved in the transition of C. glabrata from nonpathogenic commensal to a potential pathogen. Therefore more research studies are needed to explain pathogenesis, host-pathogen interaction and other survival properties of this emerging pathogen.

Not all probiotics are the same: Gut microbiota modulation with a multistrain probiotics

The highest incidence of invasive candidiasis infection (ICI) occurs in low birth weight infant with an estimated incidence of 4% and of 15% in extremely low birth weight infant. Low birth weight is an important risk factor. The other main risk factors associated with invasive candidiasis are the use of multiple antibiotics and central venous catheters, immunosuppression, parenteral nutrition, fungal colonization, and necrotizing enterocolitis. In this population, ICI cause high mortality, lead to significant neurodevelopmental impairment, and result in increate length of hospitalization and cost.[1] Originality of the study is the use of probiotics combination Alkem Batch PWS3002C comprising Bifidobacterium infantis, Lactobacillus acidophilus, Bifidobacterium longum, and Bifidum lactis. These preparations are considered more effective than single probiotic strain, characterized instead by a single bacterial strain. In fact, a recent study showed that the use of a multistrain probiotics have an action of greater efficacy.[2] Important focal point is gastrointestinal symptoms. Another interesting result of this study is that the control group presented a higher percentage of gastrointestinal symptoms than did the probiotic group, which showed an increased food tolerance, shortening the period of parenteral nutrition probably due to its changes in intestinal flora, improvement in mucosal barrier and anti-infiammatory properties. Reduction of stool fungal colonization is an important principal outcome parameter in the probiotics group by reduced invasive fungal sepsis is an important outcome parameter in the probiotics group because reduced invasive fungal sepsis 55.4% in probiotics group versus 75% in the control group.[3] Also the number of days to full enteral feeds and duration of hospitalization was less in probiotic group. Candida albicans is the most commonly isolated species, although C. parapsilosis. These species are commonly isolated in invasive candidiasis, while C. glabrata and C. krusei are isolated only in 3% of ICI. The published data show that fluconazolo use since birth is highly effective in preventing both colonization and infection in preterm neonates. This can lead to a high prevalence of azole-resistant Candida species.[4] In this study 35 (7%) newborns of control group presented C. glabrata infection, while the probiotics group presented only C. albicans. Loss of gut commensals, such as Bifidobacteria and Lactobacilli, due to the difficulties in oral feeding, translates into an increased susceptibility to pathogenic gut colonization. Probiotics are increasingly being used for their beneficial properties, considered to be particularly useful in reducing some symptoms related to gastrointestinal disorders.[5] In particular, preparations of a multistrain, consisting of different bacterial strains but belonging to the same species or anyway similar species are considered more effective than single probiotic strain. Evidence regarding the potential beneficial effects of probiotics supplementation in preterm infants is encouraging. Further studies to assess clinically relevant outcomes are needed.

Role of Dectin-2 for host defense against systemic infection with Candida glabrata.

Although Candida glabrata is an important pathogenic Candida species, relatively little is known about its innate immune recognition. Here, we explore the potential role of Dectin-2 for host defense against C. glabrata. Dectin-2-deficient (Dectin-2−/−) mice were found to be more susceptible to C. glabrata infections, showing a defective fungal clearance in kidneys but not in the liver. The increased susceptibility to infection was accompanied by lower production of T helper 1 (Th1) and Th17-derived cytokines by splenocytes of Dectin-2−/− mice, while macrophage-derived cytokines were less affected. These defects were associated with a moderate yet significant decrease in phagocytosis of the fungus by the Dectin-2−/− macrophages and neutrophils. Neutrophils of Dectin-2−/− mice also displayed lower production of reactive oxygen species (ROS) upon challenge with opsonized C. glabrata or C. albicans. This study suggests that Dectin-2 is important in host defense against C. glabrata and provides new insights into the host defense mechanisms against this important fungal pathogen.

Antifungal resistance does not necessarily affect Candida glabrata fitness

Although there has been an overall good coverage of Candida glabrata infections by the echinocandins, emergence of antifungal resistance during therapy has been reported. We investigated, by using an invertebrate host model, the fitness of sequential C. glabrata isolates with different echinocandins susceptibility patterns. The studied strains were isolated from a case of recurrent fungemia with a fatal outcome due to C. glabrata that developed cross-resistance to echinocandins during caspofungin therapy. The sequential strains isolated post-therapy showed a S663P mutation in the Fks2p hot spot 1. In vivo study in the invertebrate host Galleria mellonella did not suggest a fitness cost related to the acquired antifungal resistance, the three isolates displayed a similar rate of killing (P = 0·54). We observed a clear correlation between emergence of antifungal resistance and persistence of the causal agent, probably aided by the unchanged fitness and unresponsiveness in vivo to the adopted therapy.

Candida glabrata infection following total hip arthroplasty: A case report.

Candida glabrata infection following total hip arthroplasty is rare and, due to the insufficiency of standardized clinical and evidence-based guidelines, there is no appropriate therapeutic schedule. The present study reports the case of a 44-year-old patient with Candida glabrata infection following a total hip arthroplasty. The patient was successfully treated by administration of intravenous and oral voriconazole without removal of the prosthesis. This case illustrates the significance of postoperative follow-up, clinician experience and the choice of the correct antifungal agent. In this case, we found in the early stage of Candida glabrata infection, we were able to control the infection without surgery through thorough irrigation. This reduces patient suffering and economic burden.

Prevalence of Candida co-infection in patients with pulmonary tuberculosis

Candida species are emerging as a potentially pathogenic fungus in patients with broncho-pulmonary diseases. The synergistic growth promoting association of Candida and Mycobacterium tuberculosis has raised increased concern for studying the various Candida spp . and its significance in pulmonary tuberculosis patients during current years. This study was undertaken with the objective of discovering the prevalence of co-infection caused by different Candida species in patients with pulmonary tuberculosis. A total of 75 patients with pulmonary tuberculosis diagnosed by sputum Ziehl-Neelsen staining were included in the study. Candida co-infection was confirmed using the Kahanpaa et al. criteria. Candida species were identified using gram stain morphology, germ tube formation, morphology on cornmeal agar with Tween-80, sugar fermentation tests and HiCrome Candida Agar. Candida co-infection was observed in 30 (40%) of patients with pulmonary tuberculosis. Candida albicans was the most common isolate observed in 50% of the patients with co-infection, followed by C. tropicalis (20%) and C. glabrata (20%). Candida co-infection was found in 62.5% of female patients, while it was observed in only 29.4% of the male patients (P value 0.0133). Mean ± SD age of the patients with C. glabrata infection was 65.83 ± 3.19, while the mean ± SD age of the patients with other Candida infections was 43.25 ± 20.44 (P value 0.0138). Many patients with pulmonary tuberculosis have co-infection with Candida spp. The prevalence of non-albicans Candida species is increasing and may be associated with inadequate response to anti-tubercular drugs. C. glabrata infection has a strong association with old age.

De la colonisation digestive à l’infection systémique par Candida albicans chez le lapin sous ventilation mécanique : rôle du Toll-like receptor

The incidence of systemic nonalbicans Candida (especially C. glabrata) infections is increasing dramatically in intensive care units, but relatively little is known about the pathogenesis or host defenses associated with these life threatening infections.The course of systemic C. glabrata infection was assessed as the fungal burden in the kidneys and livers of mice sacrificed 1, 8, and 15 d after intravenous C. glabrata. Sixteen hours before each sacrifice, half of the mice were injected intraperitoneally with intact viable or nonviable E. coli cells, or with E. coli lipopolysaccharide (LPS), or with tumor necrosis factor (TNF)-α. To clarify the effect of LPS and TNF-α on phagocytosis, resident (unstimulated) mouse peritoneal macrophages were harvested, cultivated ex vivo, and some cultures were treated with LPS or TNF-α prior to 30 min incubation with C. glabrata.Compared with mice injected with vehicle, each agent (intact E. coli cells or E. coli LPS or TNF-α) was consistently associated with decreased numbers of tissue C. glabrata, and some of these decreases were significant (P < 0.05). Compared with untreated macrophages, phagocytosis of C. glabrata was increased with LPS-treated macrophages (P < 0.01), and phagocytosis was also increased in the presence of TNF-α (P < 0.01).E. coli LPS and TNF-α may participate in host defense against C. glabrata by a mechanism involving increased macrophage phagocytosis, suggesting that stimulation of inflammatory cytokines may facilitate host clearance of C. glabrata.

The Pneumocystis Ace2 Transcription Factor Regulates Cell Wall-remodeling Genes and Organism Virulence

Pneumocystis carinii (Pc) β-glucans are major components of the organism cell wall; yet, the regulation of Pc cell wall genesis and remodeling is not well understood. Ace2 transcription factors, which are present in many fungi, regulate glucanases and other enzymes needed for cell wall remodeling. The cloning and heterologous expression of PcAce2 in ace2Δ Saccharomyces cerevisiae demonstrated that PcAce2 can restore the defective glucanase and endochitinase gene expression of the mutant as well as regulate cell wall β-glucan biosynthetic genes. Furthermore, when a reconstructed yeast system was used, PcAce2 activated the transcription of the Pneumocystis gsc1 β-glucan synthetase, confirming the activity of a Pc transcription factor on a native Pneumocystis promoter and gene for the first time. We further observed that Pneumocystis binding to host extracellular matrix proteins and lung epithelial cells induced the phosphorylation (activation) of the PcAce2 transcription factor. Finally, we present a novel method that confirms the role of PcAce2 in modulating organism virulence using ace2Δ Candida glabrata infection in neutropenic mice. Together, these results indicate that the adherence of Pc to lung matrix proteins and epithelial cells leads to the activation of the Ace2 transcription factor, which regulates cell wall degradation and biosynthesis genes that are required for cell wall remodeling.

A 1-year prospective survey of candidemia in Italy and changing epidemiology over one decade

The aim of this study was to assess the epidemiology of candidemia and antifungal susceptibility profiles of Candida isolates in Italy through a prospective surveillance study and to evaluate changes compared to a previous survey performed in one Italian region (Lombardy) in 1997-1999. A prospective laboratory-based surveillance of candidemia was performed in Italy from January to December 2009. For each case a questionnaire was filled in, and the first isolate was collected and tested for in vitro antifungal susceptibility. During our 12-month survey, 467 episodes of candidemia were reported from 34 centres (30 located in Lombardy) and 464 isolates collected. Candida albicans was the predominant species (overall incidence 50.4 %), but the proportion varied considerably from 52.1 % in Lombardy hospitals to 45.2 % hospitals located outside this region. The second most frequent species was C. glabrata in Lombardy and C. parapsilosis in other regions. Comparison of the 1997-1999 and 2009 data on episodes of candidemia in Lombardy revealed a threefold increase in incidence (from 0.38 to 1.19 per 1,000 admissions), aging of infected patients, decline in crude mortality (from 35 to 27.1 %) and an increased proportion of C. glabrata etiology (from 12.8 to 20.3 %). Susceptibility testing confirmed the broad activity of amphotericin B and echinocandins. Decreased susceptibility to fluconazole was found in 24.9 % of the tested isolates. The results of this latest survey confirm the high rate of candidemia in Italy and show changes in some of the epidemiological tracts, such as aging of infected patients, increased proportion of C. glabrata infections, increased diagnosis in medical wards, and improvement in patients' survival.

A severe case of haemodynamic instability during anidulafungin administration

Anidulafugin is an echinocandin used for the treatment of candida infections in non-neutropenic adults. Echinocandins show few drug-drug interactions and are usually well tolerated. We report a case of acute hypotension, bradycardia and haemodynamic instability with consecutive cardiopulmonary resuscitation during anidulafungin administration. A 41-year-old man ICU patient received anidulafungin for a suspected Candida glabrata infection. During the first administration of the drug, he developed acute haemodynamic instability with hypotension and bradycardia. The infusion was discontinued immediately and cardiopulmonary resuscitation was performed successfully. The patient regained haemodynamic stability. To the authors' knowledge, this is the first report of a life-threatening adverse event due to haemodynamic instability during anidulafungin administration. Cardiac toxicity associated with echinocandins has been described. Further studies seem to be mandatory to investigate this potential risk.

New PCR Test for Detection of Candida glabrata Based on the Molecular Target Chosen by the RAPD Technique

Rapid, reliable diagnosis is a necessary condition for the successful treatment of infections. Such diagnostic assays are continually being developed. The paper presents a method for selecting the molecular target for PCR-based diagnostics based on the comparison of RAPD patterns. A sequence encoding Candida glabrata CBS138 hypothetical protein was selected. The limit of detection for PCR and real-time PCR reactions with DNA extracted from blood samples spiked with Candida glabrata was estimated at 1 CFU/ml. The application of the assays developed in this study would thus seem to be promising as a complementary method in the diagnostics of C. glabrata infections.

Invasive fungal infections in hematology: epidemiology and risk factors

Recent Italian and International epidemiological data show that invasive fungal infections (IFI), particularly aspergillosis, are still a crucial issue for patients with acute myeloid leukemia. However, in the last years the epidemiology is changing, and in order to determine the real risk of a patient and in order to improve preventive, diagnostic and therapeutic measures, it’s important to identify all the factors (e.g. age, performance status, prophylaxis) that play a role in the development of IFI. Immunogenetics may potentially contribute to improve diagnosis providing new therapeutic tools, but results are limited by sample size and absence of thorough functional characterization moreover lack of replication limits translation of data to the clinical practice. Regarding candidemia an Italian study showed that the overall incidence remained unchanged between 2008 and 2010 but with an increase in the number of C. albicans aand C. glabrata infections.

Invasive fungal infections in hematology: epidemiology and risk factors

Recent Italian and International epidemiological data show that invasive fungal infections (IFI), particularly aspergillosis, are still a crucial issue for patients with acute myeloid leukemia. However, in the last years the epidemiology is changing, and in order to determine the real risk of a patient and in order to improve preventive, diagnostic and therapeutic measures, it’s important to identify all the factors (e.g. age, performance status, prophylaxis) that play a role in the development of IFI. Immunogenetics may potentially contribute to improve diagnosis providing new therapeutic tools, but results are limited by sample size and absence of thorough functional characterization moreover lack of replication limits translation of data to the clinical practice. Regarding candidemia an Italian study showed that the overall incidence remained unchanged between 2008 and 2010 but with an increase in the number of C. albicans aand C. glabrata infections.

Ten-Year Study of Species Distribution and Antifungal Susceptibilities of Candida Bloodstream Isolates at a Brazilian Tertiary Hospital

To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

Effects of Anidulafungin and Voriconazole, Singly and in Combination, on Cytokine/Chemokine Production by Human Monocyte-Derived Macrophages Infected with Candida glabrata or Activated by Lipopolysaccharide

Background:Candida glabrata causes infections associated with severe sepsis, production of high concentrations of cytokines/chemokines, and high mortality. This study describes the effects of anidulafungin (ANF) and voriconazole (VRC), singly and in combination, on the production of eight cytokines/chemokines by human monocyte-derived macrophages (MDM) infected with C. glabrata or activated by lipopolysaccharide (LPS). Methods: MDM monolayers were established, infected with C. glabrata or activated with LPS, and then treated with high or low concentrations of ANF, VRC, or both. Cytokine/chemokine levels in MDM supernatants were determined. Results: Levels of cytokines/chemokines were significantly elevated in supernatants of infected or LPS-activated MDM. Except for interleukin-10, all significant decreases in cytokine/chemokine concentrations (p < 0.01) occurred in supernatants of infected MDM treated with high concentrations of ANF or ANF + VRC. Conclusions: Decreases in cytokine/chemokine levels in supernatants of infected MDM treated with high concentrations of ANF or ANF + VRC suggest that similar treatment could improve survival in patients with severe, invasive C. glabrata infections and markedly elevated levels of serum cytokines/chemokines.

Significant differences in the cell‐wall mannans from three Candida glabrata strains correlate with antifungal drug sensitivity

Candida glabrata is often the second or third most common cause of candidiasis after Candida albicans. C. glabrata infections are difficult to treat, often resistant to many azole antifungal agents and are associated with a high mortality rate in compromised patients. We determined the antigenic structure of the cell-wall mannoproteins from three C. glabrata strains, NBRC 0005, NBRC 0622 and NBRC 103857. (1)H NMR and methylation analyses of the acetolysis products of these mannoproteins showed a significant difference in the amount of the β-1,2-linked mannose residue and side-chain structure. The C. glabrata NBRC 103857 strain contained up to the triose side chains and the nonreducing terminal of the triose was predominantly the β-1,2-linked mannose residue. By contrast, the mannans of the two former strains possessed up to the tetraose side chains and the amount of the β-1,2-linked mannose residue was very low. Larger oligosaccharides than tetraose in the acetolysis products of these mannans were identified as incomplete cleavage fragments by analyzing methylation, (1)H NMR spectra and the α1-2,3 mannosidase degradation reaction. Resistance to the antifungal drugs itraconazole and micafungin was significantly different in these strains. Interestingly, the NBRC 103857 strain, which involved a large amount of the β-1,2-linked mannose residues, exhibited significant sensitivity to these antifungal drugs.

Emerging trends in candidemia: A higher incidence but a similar outcome

The clinical presentation and outcome of candidemia has changed in recent years. We compared two 5-year periods (2000-2004 and 2005-2009) in a single institution. We recorded 419 candidemia episodes during the study period (124 in the first period and 295 in the second period). We observed a significant increase in the number of cases per 1000 admissions per year, from 0.57 in 2000 to 1.52 in 2009 (χ(2) LT <0.001). Candida albicans was the most frequently isolated species (42.2%), followed by Candida parapsilosis (34.4%) and Candida glabrata (12.9%). In the second period, episodes were associated with higher comorbidity and were more commonly nosocomial, with a more frequent catheter-related source and an increased rate of C. glabrata infection. No significant differences were observed in susceptibility by species during the study period. According to multivariate analysis, the independent factors associated with higher mortality were shock, age >50 years, elevated comorbidity score (Charlson index >6), and source of candidemia other than catheter. In contrast to the increase in comorbid conditions observed in recent years, mortality remained similar during both periods (~37% during the first month). This finding could be attributed to a significant increase in catheter-related candidemia and better outcome, as well as to a potential improvement in the management of antifungal therapy in recent years.