Candiduria Among Intensive Care Unit Patients Undergoing Urinary Catheterization: Risk Factors, Effect On Candidemia and Mortality

• Main Authors: Nur YAPAR, Hatice KÖSE, Mahmut Cem ERGON, Yusuf SAVRAN, Mine DOLUCA, Vildan AVKAN OĞUZ
• Format: Article
• Language: English
• Published: Bilimsel Tip Yayinevi 2015-12-01
• Series: Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
• Subjects: Candiduria; Urinary catheterization; Intensive care unit; Candidemia; Mortality
• Online Access: http://www.floradergisi.org/getFileContent.aspx?op=REDPDF&file_name=2015-20-04-195-202.pdf
• ISSN: 1300-932X; 1300-932X

Introduction: Detection of Candida spp. in urine specimens of urinary catheterized patients hospitalized in intensive care units (ICU) is a common problem. However, the clinical importance of this situation is not clear. This study aimed to evaluate the risk factors, effect of candiduria on candidemia and mortality rates of the patients. Materials and Methods: All adult ICU patients with urinary catheterization were included into the study. The patients were followed until discharge or death without intervention. Data including age, gender, clinical features, co-morbidities, invasive procedures, hospital length of stay, antibiotic and antifungal usage were recorded by using a case report form. Candiduria was defi ned as isolation of Candida species from the urine cultures of the patients. Statistical Package for Social Sciences (SPSS) Version 15.0 was used for statistical analyses. Categorical variables were evaluated using the Chi-square and two-tailed Fisher’s exact tests. T-test was used for continuous variables. Multivariable, backward stepwise, logistic regression analysis was used for the identifi cation of independent risk factors for candiduria. Results: A total of 159 patients were observed during the study period. Of the patients, 85 (53.4%) were male, 74 (46.6%) were female, and their mean age was 68.5 ± 17.0 (17-91) years. Candiduria was detected in 59 (37.1%) patients. In multivariate analysis, diabetes mellitus (p= 0.01), cerebrovascular accident (p= 0.01), erythrocyte transfusion (p= 0.03), piperacilline-tazobactam and cephaperazone-sulbactam (p= 0.008), and carbapenem (p= 0.02) use were found as risk factors for candiduria. In the candiduria group, 15 (25.4%) patients and in the control group, 32 (32%) patients died (p= 0.37). Of the 159 patients, candidemia was detected in a total of 15 (10.4%) patients; 7 (11.8%) were in the candiduria group and 8 (8%) were in the control group. Antifungal therapy was used in 27 (45.7%) patients in the candiduria group and 18 (18%) patients in the control group (p= 0.0001); however, mortality rate was not did not change with antifungal therapy (p= 0.93). Conclusion: Candiduria is a common and confusing problem causing unnecessary antifungal usage. No signifi cant effect of candiduria on mortality was found in this study. Therefore, this situation should be managed together with clinical findings carefully.