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Intensive Care Medicine

, Volume 29, Issue 7, pp 1069–1076 | Cite as

Candiduria in critically ill patients admitted to intensive care medical units

  • Francisco Álvarez-LermaEmail author
  • Juan Nolla-Salas
  • Cristobal León
  • Mercedes Palomar
  • Ricard Jordá
  • Nieves Carrasco
  • Felipe Bobillo
Original

Abstract

Background

The purpose of this study was to determine the incidence of candiduria in critically ill patients admitted to intensive care medical units (ICUs), to identify risk factors for candiduria and to assess the frequency distribution of different Candida spp.

Subjects and methods

This was a prospective cohort observational and multicenter study. A total of 1,765 patients older than 18 years of age who were admitted for at least 7 days to 73 medical-surgical ICUs of 70 Spanish hospitals were included in the study. Urine cultures were performed once a week.

Results

In 389 patients (22%), Candida spp. in one or more urine samples were isolated. In the multivariate analysis, independent risk factors for candiduria included: age >65 years, female sex, length of hospital stay before ICU admission, diabetes mellitus, total parenteral nutrition, mechanical ventilation and previous use of antimicrobials. Candida albicans was recovered in 266 cases (68.4%), followed by C. glabrata (32 cases, 8.2%) and C. tropicalis (14 cases, 36%). Previous use of antifungal agents was the only risk factor for the selection of Candida non-albicans candiduria (OR 2.64, 95% CI 1.35–5.14, P =0.004). In-hospital mortality was 48.8% in patients with candiduria compared to 36.6% in those without candiduria ( P <0.001). Significant differences were also found for ICU mortality (38.% vs. 28.1%, P <0.001).

Conclusions

Twenty-two percent of critically ill patients admitted for more than 7 days in the ICU developed candiduria. C. albicans was the most frequent causative pathogen. Previous use of antifungals was the only risk factor for the selection of Candida non-albicans.

Keywords

Candiduria Critically ill patient Intensive care unit (ICU)  Candida albicans  Candida non-albicans 

Notes

Acknowledgements

We thank Marta Pulido, MD, for editing the manuscript and editorial assistance.

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Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Francisco Álvarez-Lerma
    • 1
    Email author
  • Juan Nolla-Salas
    • 1
  • Cristobal León
    • 2
  • Mercedes Palomar
    • 3
  • Ricard Jordá
    • 4
  • Nieves Carrasco
    • 5
  • Felipe Bobillo
    • 6
  1. 1.Department of Intensive Care MedicineHospital Universitari del MarBarcelonaSpain
  2. 2.Department of Intensive Care MedicineHospital de ValmeSpain
  3. 3.Department of Intensive Care MedicineHospital Vall d'HebrónBarcelonaSpain
  4. 4.Department of Intensive Care MedicineHospital de Son DuretaPalma de MallorcaSpain
  5. 5.Department of Intensive Care MedicineHospital de la PrincesaMadridSpain
  6. 6.Department of Intensive Care MedicineHospital ClínicoValladolidSpain

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