Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Qazvin, Iran

Abstract

Background: A broad variety of fungi, especially Candida species, are becoming increasingly common causes of urinary tract infections in hospital settings. Objectives: The current cross-sectional descriptive study aimed to determine the causative agents, risk factors and incidence rate of candiduria in critically ill patients, hospitalized in intensive care units (ICUs) of four Iranian hospitals. Patients and Methods: A total of 155 children and adult patients, admitted to ICUs of the four university educational hospitals, who demonstrated Candida-positive urine cultures, were examined. Samples were processed via mycological procedures by direct microscopy and culture. Results: Candiduria was confirmed in 50 (32.26 %) patients and Candida albicans was the most frequently isolated species representing 60.0% of isolates, followed by 14.0% C. glabrata, 12.0% C. parapsilosis, 10.0% C. krusei, and 4.0% C. tropicalis. Most patients were female (58%) with a mean age of 46.7 years old. Generally, 39.7% and 62% of adults and children showed candiduria, respectively. The commonest predisposing factors were antibiotic therapy (98.0%), urinary catheterization (92.0%), corticotherapy (84.0%), being female (42.6 %), use of feeding tube (56%), and extended hospitalization, respectively. Conclusions: The high frequency of candiduria in ICU patients can be decreased by shortening the duration of urinary catheterization, avoiding extra antibiotics and corticosteroids, as well as controlling the predisposing factors and underlying conditions.

High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern?

“…Urinary catheterization increases the risk of nosocomial UTIs up to 97% [ 9 ] and the longer durations of catheter usage lead to the appearance of more infectious organisms in the urine [ 10 ]. Fungal UTIs caused by yeast, such as Candida species, have increased in hospitalized patients over the last decade, especially HF patients [ 11 ].…”

The evaluation of the overexpression of theERG‐11,MDR‐1,CDR‐1, andCDR‐2genes in fluconazole‐resistantCandida albicansisolated from Ahvazian cancer patients with oral candidiasis

“…Fluconazole is an antifungal triazole drug which is used as the first line of systemic treatment in patients undergoing chemotherapy. Furthermore, fluconazole is widely used to prevent fungal infections in neutropenic patients with malignancy 21,22 . Various reports have shown that over the past few decades, the susceptibility of albicans and non‐ albicans species to fluconazole has gradually decreased 23,24 .…”

Epidemiology and Risk Factors for Candiduria in Hospitalized Patients at Dr. Soetomo Hospital, Surabaya, Indonesia

“…Naturally, the prevalence of candiduria is more common in female patients compared to male patients due to the reasons of anatomical and functional characteristics of the urinary system [4]. It is probably due to the shorter length of the female urethra, transmission from the female genital tract to the urinary tract, and the anti-Candida activity of prostatic fluid in males [17]. Furthermore, because the female urethra's external opening is close to the vagina and anus, which have higher levels of bacteria and yeast (i.e., approximately 75% of women will experience at least one episode of vulvovaginal candidiasis) [18], bacteria and yeast can easily enter the vagina and then enter the bladder [19].…”

“…In addition to those studies, a study conducted in Turkey in 2006 also showed that the risk of candiduria was increased by two folds in patients who had a history of diabetes mellitus compared to patients who did not have diabetes mellitus (P value=0.044; OR=2.002; 95% CI=1.013-3.957) [10]. Diabetic patients experience an increased threat of candiduria because they have a tendency for Candida colonization/infection through increased fungal growth in the urinary tract as a consequence of impaired phagocytic activity as a result of decreased host resistance to fungal invasion [17].…”

“…Corticosteroids are drugs that have been extensively used in almost all areas of medicine. Several studies have stated that corticosteroid therapy is associated with an increased incidence of candiduria [10,17]. Research conducted by Ghiasian et al (2014) stated that corticosteroid therapy was the third most common risk factor after antibiotics use and urinary catheterization [17].…”