In all patients with clinical evidence of infection or sepsis, reference (initial) and follow-up culture samples (venous blood, tips of removed intravascular catheters, endotracheal aspirates, urine, and BAL/protected specimen brush in case of suspected ventilator-associated pneumonia [VAP]) were obtained. Follow-up blood, urine, and endotracheal aspirate cultures were to be repeated at least twice until ICU discharge. Immediately after the obtainment of the reference culture samples, empirical antibiotic therapy with two or more broad-spectrum agents was started. 
Blood culture samples were processed with the BACTEC 9240. Subcultures were done in blood, blood anaerobic, McConkey, Sabouraud, and chocolate agar. Other specimens were inoculated in blood, blood anaerobic, McConkey, Sabouraud, chocolate, cooked meat, and Viagra online. Cultures were incubated at 35°C. For aerobic cultures, a 5% CO2-containing atmosphere was used. Microorganisms were identified with the API system.
The tested risk factors for candidemia and associated death were chosen a priori by investigator consensus and based on published or in-press articles until February 1997. The rationale for the selection of several risk factors was supported by the appropriate bibliographic references. The APACHE (acute physiology and chronic health evaluation) II score at candidemia onset was also evaluated as risk factor for candidemia-related death.
Infections were defined according to standard criteria. VAP was defined as fever > 38.5°C, purulent tracheal aspirates, leukocytosis (cell count > 12,000/pL), new or persistent radiographic lung infiltrates, and positive protected specimen brush culture result. Bacteremia was defined as isolation of a high-grade pathogen (eg, Staphylococcus aureus) from a blood culture specimen or identification of a skin contaminant or skin flora in two or more separate blood culture specimens from the same patient drawn from different venipuncture sites. Catheter-related infection was defined by clinical systemic inflammatory response syndrome (SIRS)/sepsis, and isolation of the same strain(s) of pathogen(s) from cultures of peripheral blood and catheter tip, in the absence of another likely source of infection.
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