Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics

Abstract

Hospital-acquired candiduria (HAC) is a well-known finding, related to severely ill patients, prolonged antibiotic treatment, use of catheters, and invasive procedures. However, the risk factors and clinical significance of community-acquired candiduria (CAC) has not yet been described. In this study, the prevalence and clinical characteristics of CAC and HAC were compared. Demographic and clinical data from all patients with positive urinary cultures sent to the bacteriology laboratory of the Haemek Medical Center, Israel, between May 2005 and October 2006 which grew Candida spp. were collected and analyzed. A total of 100,522 urine samples were received, 19,611 (19.5%) of which grew uropathogens. Among them, 204 (125 community-acquired and 79 hospital-acquired) grew Candida spp. (1% of all positive and 0.2% of all samples). Patients with CAC were younger than those with HAC (mean 50.5 years vs. 68.3 years). Pregnant women and bed-ridden patients were more prevalent in CAC (22.5% vs. 1.9% and 46.8% vs. 18.55%, respectively). More patients with HAC suffered from renal failure (27.8% vs. 11.2%) and fever (62.0% vs. 25.6%), had urinary catheters (32.9% vs. 15.2%), and received antibiotic or immunosuppressive therapy in the last month (73.4% vs. 46.4% and 10.1% vs. 3.2%). Most candiduria cases were not treated medically and no further investigation was conducted. Significant differences between patients with CAC and HAC were found. Our results confirm that candiduria (nosocomial as community-acquired) infrequently requires intervention. However, the identification of high-risk patients is desirable and questions regarding the management of candiduria, both CAC and HAC, still remain unresolved.

Epidemiological Study on Species Identification and Susceptibility Profile of Candida in Urine

“…Consistent with our observations, Colodner et al also reported higher incidence of CA-UTI in females than males. However, in this study patients were significantly younger compared to the HA-UTI group in there finding [18].…”

“…Recent studies highlight the changing epidemiology of community and nosocomial candiduria [6,7,14,18]. Our data showed that C. albicans remained as the prominent species isolated from urine cultures in both community and hospital setting, 85% and 68% respectively.…”

“…Moreover, the mortality rates in our population group were higher in the HA-CUTI patients (20% vs. 0%). Comparatively, studies have shown higher mortality in that same group [18,21] (Table 2).…”

“…Compelling evidence links antibiotic usage to the increased incidence of CUTI [17][18][19]. Certainly, most of incidence of CUTI is likely to be underestimating, mainly because the use of standard urine culture is not very sensitive.…”

Candida Infections of the Genitourinary Tract

“…Even in adults, CFU criteria to diagnose candiduria range from 10 3 to 10 5 CFU/ml urine. In some studies candiduria is even differentially defined for women and men (57). Treatment trials funded by the National Institutes of Health generally use the lower CFU cutoff (10 3 ) as their definition (241).…”