Candidemia remains a major public health challenge due to its high mortality rates, especially in developing countries. Monitoring epidemiological trends may provide insights for better clinical outcomes. This study aimed to describe trends in the epidemiology, therapeutic practices, and mortality in candidemia through a retrospective comparative analysis between two surveillance cohorts of all candidemic adults at eleven tertiary hospitals in Brazil, from 2010-2011 (Period I) versus 2017-2018 (Period II). A total of 616 cases were diagnosed, with 247 being from Period II. These patients were more likely to have three or more coexisting comorbidities 72 (29.1%) vs. 60 (16.3%), < 0.001, had a prior history of in-hospital admissions more often 102 (40.3%) vs. 79 (21.4%), = 0.001, and presented with candidemia earlier after admission, within 15 days (0-328) vs. 19 (0-188), = 0.01. Echinocandins were more frequently prescribed 102 (41.3%) vs. 50 (13.6%), = 0.001, but time to antifungal initiation 2 days (0-14) vs. 2 (0-13), = 0.369 and CVC removal within 48 h 90/185 (48.6%) vs. 148/319 (46.4%), = 0.644 remained unchanged. Additionally, many patients went untreated in both periods I and II 87 (23.6%) vs. 43 (17.4%), = 0.07, respectively. Unfortunately, no improvements in mortality rates at 14 days 123 (33.6%) vs. 93 (37.7%), = 0.343 or at 30 days 188 (51.4%) vs. 120 (48.6%), = 0.511 were observed. In conclusion, mortality rates remain exceedingly high despite therapeutic advances, probably associated with an increase in patients' complexity and suboptimal therapeutic interventions. Management strategies should be tailored to suit epidemiological changes, expedite diagnosis to reduce the number of untreated eligible patients and guarantee early antifungal initiation and source control.