For a study, it was determined that candidemia is an infection causing substantial morbidity and mortality. An increasing proportion of non-albicans Candida species and rising antifungal drug resistance is responsible for the Infectious Diseases Society of America (IDSA) treatment change guidelines in 2016 to recommend echinocandins over fluconazole as first-line treatment for adults with candidemia. During 2017–2018, the Emerging Infections Program conducted active population-based candidemia surveillance at 9 US sites using a standardized case definition. A study assessed factors related to initial antifungal treatment for the first candidemia case among adults with multivariable logistic regression models. Comparable to the first antifungal drug received with species and antifungal susceptibility testing (AFST) outcomes from initial blood cultures were done. Among 1,835 patients who received antifungal treatment, 1,258 (68.6%) received an echinocandin and 543 (29.6%) received fluconazole as initial treatment. Cirrhosis (adjusted odds ratio=2.06; 95% confidence interval, 1.29–3.29) was the only medical condition significantly associated with the initial receipt of an echinocandin (vs fluconazole). More than one-half (n=304, 56.0%) of patients initially treated with fluconazole grew a non-albicans species. Patients with candidemia were initially treated with fluconazole, resulting in inappropriate treatment for those involving non-albicans or fluconazole-resistant species.