The Presence of Candida spp. in Urine Culture: Colonization or Infection ?

Aim: The aim of this study is to analyse the peculiarities of candiduria among intensive care unit pacients. Objectives: 1. Evaluate the risk factors for candiduria. 2. Identify the most common Candida species. 3. Evaluate Candida spp. susceptibility to antifungal agents. 4. Estimate the number of pacients with candiduria who were treated with antifungal agents. Methods: A retrospective analysis of medical history and laboratory test data was done for patients with candiduria who were treated in LSMU KK Intensive care unit (ICU) in 2018. Results: Out of 53 patients with candiduria, 68% were women and 32% were men. The mean age of patients was 64,51 ± 18,93. Predisposing factors for candiduria were use of antibiotics (86,79%), urinary catheterization (33,96%), diabetes mellitus (22,64%), malignancies (15,09%), concomitant bacteriuria (11,32%), kidney stones (5,66%), immunosuppressive therapy (5,66%), instrumentation of the urinary tract (3,77%). Candida albicans was the most common species isolated (53,7%) followed by Candida glabrata (22,22%), Candida kefyr (9,26%), Candida tropicalis (5,56%), Candida krusei (5,56%), Candida parapsilosis (1,85%), Candida guilliermondii (1,85%). 13,21% of patients had polymicrobial candiduria where Candida was identified with bacteria or two Candida species were identified together. The results from antifungal susceptibility test revealed that most of Candida isolates were susceptible to fluconazole (83,33%) except all C. krusei and some C. glabrata strains. All species showed 100% susceptibility to amphotericin B and flucytosine and 98,15% susceptibility to voriconazole. Candida strains were least susceptible to itraconazole (74,07%). 43,4 % of patients were treated with antifungal agent and fluconazole was the most frequently used antifungal (96,65%). Conclusions: 1. The major predisposing factor for candiduria was prior antibiotic use followed by catheterisation of urinary tract and diabetes mellitus. Candiduria was more common in women than men and in older patients. 2. The most common isolates were Candida albicans, Candida glabrata and Candida kefyr. 3. All Candida strains were susceptible to amphotericin B and flucytosine. Some of them were resistant to fluconazole, voriconazole and itraconazole. Antifungal resistance was most commonly found in C. glabrata and C. krusei strains. 4. 43 % of patients were treated with antifungal agent