2026 Critical Care Congress Skip to main content
2026 Critical Care Congress Main banner
Final Program


Advance Program
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Session Icons
Thought Leader Session
Thought Leader Session
Guidelines Session
Guidelines Session
Aging Adult Track
Aging Adult Track
Additional Registration Fee
Additional Registration Fee

Research Snapshot Theater: Sepsis/Infectious Disease, Adult

Empiric Antifungal Therapy for Critically Ill Patients With Candidemia

Monday, March 23, 2026
10:15 AM - 11:15 AM Central Time
Location: Connections Central - RST 16
  • CV

    Chandni Vashee, MD

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • KO

    Konstantinos Ouranos, MD

    Dr.
    Department of Medicine, Houston Methodist Hospital, Houston, TX USA

    Disclosure information not submitted.

  • VP

    Vinayika Papineni, MD

    Dr.
    Department of Medicine, Houston Methodist Hospital, Houston, TX USA

    Disclosure information not submitted.

  • AS

    Aarjav Sanghvi, N/A

    Mr.
    Center of Health Data Science and Analytics, Houston Methodist Hospital, Houston, TX, USA

    Disclosure information not submitted.

  • WH

    Wesley Hoffman, PharmD

    RPh
    Department of Pharmacy, Houston Methodist Hospital, Houston, TX USA

    Disclosure information not submitted.

  • MA

    Max Adelman, MD, MS

    Dr.
    Division for Pulmonary Critical Care, and Sleep Medicine; Division for Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, TX USA; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX USA

    Disclosure information not submitted.

Introduction: Candidemia is a common cause of infection in the intensive care unit (ICU). Diagnosis is challenging, and antifungal therapy is often delayed until culture confirmation although empiric therapy may improve outcomes. In this study we evaluated whether initiating antifungal therapy prior to blood culture positivity improves mortality in critically ill patients with candidemia.


Methods: We conducted a retrospective cohort study of patients with candidemia at a large healthcare system in Houston, Texas between 2016 and 2024. We excluded patients on antifungals at time of blood culture collection, or who did not receive antifungals within 5 days of culture collection. We compared patients who received empiric antifungal therapy within 24 hours of culture collection and those who received antifungals after 24 hours.


Results: Among 399 patients with candidemia, 97 (24.3%) received antifungals within 24 hours of blood culture collection, and 302 (75.7%) received antifungals after 24 hours; only 4.5% were started on antifungals within 3 hours. Mean time to antifungal was 39.4 hours (SD 22.0). There was no difference in vital signs between patients who received antifungals before or after 24 hours. 7-day mortality was 47 (11.8%) and 30-day mortality was 102 (25.6%). Among ICU patients, 7-day mortality was 23.9% (vs 5.1% in non-ICU patients) and 30-day mortality was 51.4% (vs 11.3% in non-ICU patients). There was no significant statistical difference (p = 0.16) in overall mortality when antifungal therapy was initiated within 24 hours (30/97, 30.9%) vs after 24 hours (72/302, 23.8%) from cultures being drawn.


Conclusions: Most patients experienced delayed antifungal initiation (mean 40h post-culture), despite the known benefit of early therapy in candidemia. In our cohort, mortality did not differ between the two groups, possibly due to confounding by severity - sicker patients may have received earlier treatment but still had worse outcomes. These findings highlight the need for improved diagnostics to facilitate timely antifungal therapy in critically ill patients with suspected candidemia.