Clinician response to Candida organisms in the urine of patients attending hospital

  • S. C. A. Chen
  • Z. S. Tong
  • O. C. Lee
  • C. Halliday
  • E. G. Playford
  • F. Widmer
  • F. R. Kong
  • C. Wu
  • T. C. Sorrell


The epidemiology of 54 episodes of candiduria with respect to clinical risk factors, species of Candida and physician response to the isolation of Candida in urine were studied in an observational survey over 3 months. Candida spp. were isolated from 4.7% of positive urine cultures. Common predisposing conditions included antibiotic use (74.1%), urinary drainage devices (57.4%), surgery (51.9%), intensive care unit (ICU) or high-dependency care unit (HDU) admission (42.6%) and urinary tract (UT) disease (18.5%). Upper UT infection was uncommon (n = 3). Of 65 Candida isolates, C. albicans predominated (85.2%), followed by C. glabrata (27.8%) and other Candida spp. (6.2%). All isolates were susceptible to fluconazole, itraconazole, voriconazole, amphotericin and caspofungin. Indwelling urinary catheters were removed in 76.2% of episodes. Antifungal therapy was initiated in 33.3% of cases independently of patient symptoms, underlying disease or Candida colony count. Patients in ICU/HDUs were significantly more likely to receive antifungal agents than those outside these units (p < 0.001). Fluconazole was the most common drug prescribed (77.8%). Clearance of candiduria occurred independently of antifungal therapy (p = 0.60). Physicians often did not follow up a positive urine result for Candida. Efforts to increase clinician awareness of current recommendations for managing candiduria and further study to elucidate specific risk factors in defined patient populations are warranted.


  1. 1.
    Kauffman CA, Nazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW et al (2000) Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 30:14–18PubMedCrossRefGoogle Scholar
  2. 2.
    Álvarez-Lerma F, Nolla-Sala J, León C, Palomar M, Jordá R, Carrasco N et al (2003) Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 29:1069–1076PubMedCrossRefGoogle Scholar
  3. 3.
    Richards MJ, Edwards JR, Culver DH, Gaynes RP (2000) Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 21:510–515PubMedCrossRefGoogle Scholar
  4. 4.
    Bouza E, San Jaun R, Munoz P, Voss A, Kluytmans J (2001) A European perspective on nosocomial urinary tract infections. I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI-003 study). Clin Microbiol Infect 7:523–531PubMedCrossRefGoogle Scholar
  5. 5.
    Febré N, Silva V, Medeiros EAS, Wey SB, Colombo AL, Fischman O (1999) Microbiological characteristics of yeasts isolated from urinary tracts of intensive care unit patients undergoing urinary catheterization. J Clin Microbiol 37:1584–1586PubMedGoogle Scholar
  6. 6.
    Lundstrom T, Sobel J (2001) Nosocomial candiduria: a review. Clin Infect Dis 32:1602–1607PubMedCrossRefGoogle Scholar
  7. 7.
    Ayeni O, Riederer KM, Wilson FM, Khatib R (1999) Clinicians’ reaction to positive urine culture for Candida organisms. Mycoses 42:285–289PubMedCrossRefGoogle Scholar
  8. 8.
    Hamory BH, Wenzel RP (1978) Hospital-associated candiduria: predisposing factors and review of the literature. J Urol 120:444–448PubMedGoogle Scholar
  9. 9.
    Schaberg DR, Culver AH, Gaynes RP (1991) Major trends in the microbial etiology of nosocomial infection. Am J Med 91(Suppl 3B):72S–74SPubMedCrossRefGoogle Scholar
  10. 10.
    Fisher JF, Newman CL, Sobel JD (1995) Yeast in the urine: solutions for a budding problem. Clin Infect Dis 20:183–189PubMedGoogle Scholar
  11. 11.
    Koznin PJ, Taschdjian CL, Goldberg PK, Wise GJ, Toni EF, Seelig MS et al (1978) Advances in the diagnosis of renal candidiasis. J Urol 119:184–187Google Scholar
  12. 12.
    Chabasse D (2001) Yeast count in urine. Review of the literature and preliminary results of a multicenter prospective study carried out in 15 hospital centers. Ann Fr Anesth Reanim 20:400–406PubMedGoogle Scholar
  13. 13.
    Sellami A, Sellami H, Makni F, Bahloul M, Cheikh-Rouhou F, Bouaziz M et al (2006) Candiduria in intensive care unit: significance and value of yeast numeration in urine. Ann Fr Anesth Reanim 25:584–588PubMedGoogle Scholar
  14. 14.
    Falagas ME, Gorbach SL (1995) Practice guidelines: urinary tract infections. Infect Dis Clin Pract 4:241–257CrossRefGoogle Scholar
  15. 15.
    Pappas PG, Rex JH, Sobel JD, Filler SG, Dismukes WE, Walsh TJ, Edwards JE; Infectious Diseases Society of America (2004) Guidelines for treatment of candidiasis. Clin Infect Dis 38:161–189PubMedCrossRefGoogle Scholar
  16. 16.
    Sobel JD, Kauffman CA, McKinsey D, Zervos M, Vazquez JA, Karchmer AW et al (2000) Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 30:19–24PubMedCrossRefGoogle Scholar
  17. 17.
    Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J, Crokaert F et al (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14PubMedCrossRefGoogle Scholar
  18. 18.
    Infection control guidelines for the prevention of transmission of infectious diseases in the health care setting. Australian Government, Department of Health and Aging, Canberra, Australia (2004) Available online at
  19. 19.
    National Committee for Clinical Laboratory Standards (NCCLS) (2002) Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard, NCCLS document M27-A2, 2nd edn. NCCLS, Wayne, PennsylvaniaGoogle Scholar
  20. 20.
    Espinell-Ingroff A, Barchiesi F, Cuenca-Estrella M, Fothergill A, Pfaller MA, Rinaldi M et al (2005) Comparison of visual 24-hour and spectrophotometric 48-hour MICs to CLSI reference microdilution MICs of fluconazole, itraconazole, posaconazole, and voriconazole for Candida spp.: a collaborative study. J Clin Microbiol 43:4535–4540CrossRefGoogle Scholar
  21. 21.
    Shay AC, Miller LG (2004) An estimate of the incidence of candiduria among hospitalized patients in the United States. Infect Control Hosp Epidemiol 25:894–895PubMedCrossRefGoogle Scholar
  22. 22.
    Kobayashi CCBA, de Fátima Lisboa Fernandes O, Miranda KC, de Sousa ED, do Rosario Rodrigues Silva M (2004) Candiduria in hospital patients: a study prospective. Mycopathologia 158:49–52PubMedCrossRefGoogle Scholar
  23. 23.
    Gubbins PO, Pisctielli SC, Danziger LH (1993) Candidal urinary tract infections: a comprehensive review of their diagnosis and management. Pharmacotherapy 13:110–127PubMedGoogle Scholar
  24. 24.
    Safdar N, Slattery WR, Knasinski V, Gangnon RE, Li Z, Pirsch JD et al (2005) Predictors and outcomes of candiduria in renal transplant recipients. Clin Infect Dis 40:1413–1421PubMedCrossRefGoogle Scholar
  25. 25.
    Sobel JD, Vazquez JA (1999) Fungal infections of the urinary tract. World J Urol 17:410–414PubMedCrossRefGoogle Scholar
  26. 26.
    Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R (1994) Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 220:751–758PubMedCrossRefGoogle Scholar
  27. 27.
    Pelz RK, Lipsett PA, Swoboda SM, Diener-West M, Hammond JM, Hendrix CW (2000) The diagnostic value of fungal surveillance cultures in critically ill patients. Surg Infect (Larchmt) 1:273–281CrossRefGoogle Scholar
  28. 28.
    Kędzierska A, Kochan P, Peitrzyk A, Kędzierska J (2007) Current status of fungal cell wall components in the immunodiagnostics of invasive fungal infections in humans: galactomannan, mannan and (1→3)-β-D-glucan antigens. Eur J Clin Microbiol Infect Dis 26:755–766PubMedCrossRefGoogle Scholar
  29. 29.
    Paul N, Mathai E, Abraham OC, Mathai D (2004) Emerging microbiological trends in candiduria. Clin Infect Dis 39:1743–1744PubMedCrossRefGoogle Scholar
  30. 30.
    de Oliveira RD, Maffei CM, Martinez R (2001) Nosocomial urinary tract infections by Candida species. Rev Assoc Med Bras 47:231–235PubMedCrossRefGoogle Scholar
  31. 31.
    Rho J, Shin JH, Song JW, Park M-R, Kee SJ, Jang SJ et al (2004) Molecular investigation of two consecutive nosocomial clusters of Candida tropicalis candiduria using pulsed-field gel electrophoresis. J Microbiol 42:80–86PubMedGoogle Scholar
  32. 32.
    Jang SJ, Han HL, Lee SH, Ryu SY, Chaulagain BP, Moon YL et al (2005) PFGE-based epidemiological study of an outbreak of Candida tropicalis candiduria: the importance of medical waste as a reservoir of nosocomial infection. Jpn J Infect Dis 58:263–267PubMedGoogle Scholar
  33. 33.
    Prescribing information: VFEND (voriconazole), Pfizer Australia Pty Ltd, version: pfpvfend10406, 12 April 2006; pp 1–31Google Scholar
  34. 34.
    Denning DW (2003) Echinocandin antifungal drugs. Lancet 362:1142–1151PubMedCrossRefGoogle Scholar
  35. 35.
    Sobel JD, Bradshaw SK, Lipka CJ, Kartsonis NA (2007) Caspofungin in the treatment of symptomatic candiduria. Clin Infect Dis 44:e46–e49PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • S. C. A. Chen
    • 1
    • 3
  • Z. S. Tong
    • 2
  • O. C. Lee
    • 3
  • C. Halliday
    • 1
    • 3
  • E. G. Playford
    • 4
  • F. Widmer
    • 1
  • F. R. Kong
    • 3
  • C. Wu
    • 3
  • T. C. Sorrell
    • 1
  1. 1.Centre for Infectious Diseases and Microbiology and the University of Sydney at WestmeadWestmead HospitalSydneyAustralia
  2. 2.Research Laboratory for Infectious Skin Diseases, Department of DermatologyWuhan First HospitalWuhanPeople’s Republic of China
  3. 3.Centre for Infectious Diseases and Microbiology Laboratory ServicesWestmead HospitalSydneyAustralia
  4. 4.Infection Management ServicesPrincess Alexandra HospitalBrisbaneAustralia

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