This multicentre study (i) evaluated geographic and temporal changes in candidaemia ecology in the critically ill, (ii) identified risk factors associated with non-albicans candidaemia and (iii) examined the association of Candida ecology with mortality. A retrospective cohort study of patients who developed candidaemia in four general Intensive Care Units located in Australia, Greece, Belgium and Brazil was performed. Two hundred Candida organisms were identified by positive blood culture in 189 patients, including 112 Candida albicans (56.0%), 38 Candidaglabrata (19.0%), 21 Candidaparapsilosis (10.5%), 18 Candidatropicalis (9.0%), 6 Candidakrusei (3.0%), 1 Candidafamata (0.5%), 1 Candidazeylanoides (0.5%) and 3 non-differentiated Candida spp. (1.5%). No trend towards increased non-albicans species over the study period (P=0.68) or by geographic area (P=0.35) was demonstrated. Independent risk factors for non-albicans candidaemia included: female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.13-3.86] and increased central venous catheter days (OR 1.16 per 5-day interval, 95% CI 1.05-1.28). Mortality in the non-albicans group was non-significantly higher than in the albicans group (65% vs. 53%; P=0.10). This study is unique in that a large number of intensive care candidaemias in four geographically diverse units have been studied.