This multicenter retrospective study investigated the clinical heterogeneity of candidemia in critically ill patients to identify distinct clinical phenotypes and evaluate their 90-day mortality. Analyzing 492 intensive care unit (ICU) patients across 16 French centers from 2015 to 2023, researchers utilized advanced unsupervised clustering techniques—specifically, factor analysis of mixed data (FAMD) followed by hierarchical clustering on principal components (HCPC)—to group patients based on baseline categorical and continuous variables. Survival outcomes were then evaluated using Kaplan–Meier curves and Cox proportional hazards models.

The clustering analysis successfully identified three distinct clinical phenotypes with significantly different 90-day mortality rates, which averaged 62.6% overall.

Phenotype 1 (14.2% of patients) represented severely immunosuppressed individuals, primarily with hematological malignancies and high illness severity scores, yielding the highest mortality at 72.9%. Phenotype 2 (45.3%) consisted of elderly cirrhotic patients with early-onset digestive candidemia, facing a similarly high mortality rate of 70.4%.

Conversely, Phenotype 3 (40.5%) comprised younger patients with lower severity scores and catheter-related candidemia, experiencing a significantly lower mortality rate of 50.3%.

Ultimately, the study concluded that independent predictors of increased mortality included advanced age, cirrhosis, and higher baseline severity scores (SAPS II).

In contrast, the use of echinocandins and a proven catheter-related source of infection were identified as protective factors against mortality, while general immunodepression showed no direct association with survival outcomes.

These findings highlight that subtyping ICU patients with candidemia can reveal vastly different risk profiles, potentially paving the way for more tailored clinical management.

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