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Candiduria in critically ill patients admitted to intensive care medical units



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.


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).


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.

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  1. Fisher JF, Chew WH, Shadomy S, Duma RJ, Mayhall CG, House WC (1982) Urinary tract infections due to Candida albicans. Rev Infect Dis 4:1107–1118

    CAS  PubMed  Google Scholar 

  2. Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91 [Suppl 3B]: 65–71

  3. Gubbins PO, Piscitelli SC, Danziger LH (1993) Candidal urinay tract infections: a comprehensive review of their diagnosis and management. Pharmacotherapy 13:110–127

    CAS  PubMed  Google Scholar 

  4. Storfer SP, Medoff G, Fraser VJ, Powderly WG, Dunagan WC (1994) Candiduria: retrospective review in hospitalized patients. Infect Dis Clin Pract 3:23–29

    Google Scholar 

  5. Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW, Sugar AM, Sharkey PK, Wise GJ, Mangi R, Mosher A, Lee JY, Dismukes WE (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 30:14–18.

    Article  CAS  PubMed  Google Scholar 

  6. Center for Infectious Diseases (2000) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 28:429–448

    Article  PubMed  Google Scholar 

  7. Chabasse D (2001) Yeast count in urine. Review of literature and preliminary results of a multicenter prospective study carried out in 15 hospital centers. Ann Fr Anesth Reanim 20:400–406

    Article  CAS  PubMed  Google Scholar 

  8. Olaechea P, Alvarez Lerma F, de la Cal MA, Palomar M, Insausti J, y Grupo de Estudio de Vigilancia de Infección Nosocomial en UCI (2000) Evolución de la etiología de las infecciones urinarias relacionadas con sondaje uretral (abstract P131). Med Intensiva 24 [Suppl 1]:63

  9. Harris AD, Castro J, Sheppard DC, Carmeli Y, Samore MH (1999) Risk factors for nosocomial candiduria due to Candida glabrata and Candida albicans. Clin Infect Dis 29:926–928

    CAS  PubMed  Google Scholar 

  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    CAS  PubMed  Google Scholar 

  11. Center for Diseases Control (1992). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adult. MMWR 41 (RR-17):1–19

    Google Scholar 

  12. Goldman L, Hashimoto B, Cook EF, Loscalzo A (1981) Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 64:1227–1234

    CAS  PubMed  Google Scholar 

  13. Richards MJ, Edwards JR, Culver DH, Gaynes RP, the National Nosocomial Infections Surveillance System (2000) Nosocomial infections in combined medical-surgical Intensive Care Units in the United States. Infect Control Hosp Epidemiol 21:510–515

    CAS  PubMed  Google Scholar 

  14. Richards MJ, Edwards JR, Culver DH, Gaynes RP, and the National Nosocomial Infections Surveillance System (1999) Nosocomial infections in medical Intensive Care Units in the United States. Crit Care Med 27:887–892

    CAS  PubMed  Google Scholar 

  15. Alvarez Lerma F, Cerda E, Jorda R, Palomar M, Bermejo B and ICU (EPIFUCI) Fungal Infection Study Group (2000) Fungal isolates in critically ill patients admitted to intensive care units (abstract 75). Intensive Care Med 26 [Suppl 3]: S235

  16. Hamory BH, Wenzel RP (1978) Hospital-associated candiduria: predisposing factors and review of the literature. J Urol 2:444–448

    Google Scholar 

  17. Rivett AG, Perry JA, Cohen J (1986) Urinary candidiasis: a prospective study in hospital patients. Urol Res 14:183–186

    CAS  PubMed  Google Scholar 

  18. Klimek JJ, Sayers R, Kelmas BW, Quintiliani R (1979) Statistical analysis of factors predisposing to candiduria. Conn Med 43:364–365

    CAS  PubMed  Google Scholar 

  19. Golberg PK, Kozinn PJ, Wise GJ, Nouri N, Brooks RB (1979) Frequency and significance of candiduria. JAMA 241:582–584

    PubMed  Google Scholar 

  20. Schönebeck J (1972) Asymtomatic candiduria. Scand J Urol Nephrol 6:136–146

    PubMed  Google Scholar 

  21. Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N (1996) Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infection in elderly patients. Clin Infect Dis 22:30–35

    CAS  PubMed  Google Scholar 

  22. Nassoura Z, Ivatury RR, Simon RJ, Jabbour N, Stahl WM (1993) Candiduria as an early marker of disseminated infection in critically ill surgical patients: the role of fluconazole therapy. J Trauma 15:290–295

    Google Scholar 

  23. Blumberg HM, Jarvis WR, Soucie JM, Edwards JE, Patterson JE, Pfaller MA, Rangel-Frausto MS, Rinaldi MG, Saiman L, Wiblin RT, Wenzel RP (2001) Risk factors for candidal bloodstream infections in Surgical Intensive Care Unit patients: The NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey. Clin Infect Dis 33:177–186

    CAS  PubMed  Google Scholar 

  24. Fisher JF, Newman CL. Sobel JD (1995) Yeast in the urine: solutions for a budding problem. Clin Infect Dis 20:183–189

    CAS  PubMed  Google Scholar 

  25. Nguyen MH, Peacock JE Jr, Morris AJ, Tanner DC, Nguyen ML, Snydman DR, Wagener MM, Rinaldi MG, Yu VL (1996) The changing face of candidemia: emergence of non-Candida albicans species and antifungal resistance. Am J Med 100:617–623

    CAS  PubMed  Google Scholar 

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

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Correspondence to Francisco Álvarez-Lerma.

Additional information

This study was carried out with the EPCAN Study Group: J. Nolla, F. Álvarez-Lerma, M Salvadó (Hospital del Mar, Barcelona); N. Carrasco, A. Bueno (Hospital de la Princesa, Madrid); F. Bobillo, P. Ucio (Hospital Clínico, Valladolid); M.A. León, M. Nolla, R.A. Díaz (Hospital General de Cataluña, Barcelona); J.R. Iruretagoyena, K. Esnaola, I. Andetxaga (Hospital de Cruces, Bilbao); A. Blanco, F. Taboada, R. Fernández (Hospital Nuestra Señora de Covadonga, Oviedo); M. Nieto, R. Diego, F. Ortuño (Hospital Clínico San Carlos, Madrid); P. Marcos, E. Mesalles (Hospital Germans Trias i Pujol, Badalona, Barcelona); A. Martínez, M. Fernández, F. Jaime (Hospital Virgen de la Arrixaca, Murcia); H. Sancho, N. Izquierdo (Hospital Reina Sofía, Córdoba); M. Ulibarrena, F. Labayen (Hospital Santiago Apóstol, Vitoria); F. Barcenilla, M.J. Gil, B. Balsera (Hospital Arnau de Villanova, Lleida); R. Jordá, M. Jurado, J. Pérez (Hospital Son Dureta, Palma de Mallorca); E. Zavala, A. Alcón, N. Fabregues (Hospital Clínic i Provincial, Barcelona); M.V. de la Torre, M.A. Estecha, A. Soler (Hospital Virgen de la Victoria, Málaga); M. Bodí, D. Castander (Hospital Joan XXIII, Tarragona); A. Mendía, J. Artaetxebarría, C. Reviejo (Hospital Nuestra Señora de Aránzazu, San Sebastián); M. Sánchez, A. Casamitjana, C. Pérez (Hospital Insular, Las Palmas de Gran Canaria); M.J. López, E. Robles (Hospital General de Segovia, Segovia); Y. Insausti, J.A. Tihistsa (Hospital de Navarra, Pamplona); C. García, J.M. Rubio (Hospital 12 de Octubre, Madrid); R. Oltra, O. Rodríguez (Hospital Clínico Universitario, Valencia); P. Olaechea, R. de Celís (Hospital de Galdakao, Bizkaia); J.M. Soto, J. Pomares (Hospital San Cecilio, Granada); J. Luna, G. Masdeu (Hospital Virgen de la Cinta, Tarragona); R. Sierra, A. Gordillo (Hospital Puerta del Mar, Cádiz); R. Rodríguez, J. Fajardo (Hospital Virgen de la Macarena, Sevilla); M.A. Herranz, J.I. Gómez (Hospital Río Hortega, Valladolid); R.M. García, M.J. Espina (Hospital de Cabueñes, Gijón); J. Garnacho, C. Ortiz (Hospital Virgen del Rocío, Sevilla); M. Palomar, J. Montero J (Hospital Vall d'Hebron, Barcelona); C. Cisneros, A. Sandiumenje (UCI de Traumatología, Hospital 12 de Octubre, Madrid); M. Sánchez, M. Álvarez (Hospital Príncipe de Asturias, Madrid); V. López, R. Julve (Hospital de Sagunto, Valencia); J. Solé, M. Valerón (Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria); M.A. Blasco, S. Borrás (Hospital Dr. Peset, Valencia); E. Maraví, J.M. Urtasun (Hospital Virgen del Camino, Pamplona); C. Sánchez-Díaz (Hospital San Pedro de Alcántara, Cáceres); L.M. Tamayo (Hospital Río Carrión, Palencia); J. Blanco (Complexo Hospitalario Xeral-Calde, Lugo); P. Galdós (Hospital General de Móstoles, Madrid); F. Barredo (Hospital de Torrecárdenas, Almería); A. Rodríguez (Hospital Santa María del Rosell, Cartagena); J. Castaño (Hospital Virgen de las Nieves, Granada); A. Bonet (Hospital Josep Trueta, Girona); M. Cerdá (Hospital de la Creu Roja, L'Hospitalet de Llobregat, Barcelona); A. Torres (UVIR, Hospital Clínic i Provincial, Barcelona); F. Pérez F (Fundación Jiménez Díaz, Madrid); J.M. Flores (UCI Traumatología, Hospital Virgen del Rocío, Sevilla); R. Diego (Hospital General Universitario, Valencia); C. Fernández (Complejo Hospitalario Insalud, León); A. Mas (Centre Hospitalari i Cardiologic, Manresa, Barcelona); F. Ruiz (Hospital Ciudad de Jaén, Jaén); C. León, (Hospital Nuestra Señora de Valme, Sevilla); M. Casanovas (Hospital de Igualada, Igualada, Barcelona); E.A. Sanz (Hospital Santa Ana, Motril, Granada); J.A. Artola (Hospital Naval de San Carlos, Cádiz); M.P. Luque (UCI de Traumatología, Hospital Clínico Univresitario, Zaragoza); C. Palazón (Hospital General Universitario, Murcia); C. Sotillo (Hospital Gregorio Marañón, Madrid); A. Bisbal (Policlínica Miramar, Palma de Mallorca); M.J. Huertos (Hospital de Puerto Real, Cádiz); F. Esteban (Hospital Sant Joan de Reus, Reus, Tarragona); P. Ugarte (Hospital Marqués de Valdecilla, Santander); R. Giral (Hospital General Yagüe, Burgos); V. González (Hospital Miguel Servet, Zaragoza); M.J. Serralta (Hospital San Juan, Alicante); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria-Gasteiz); A. Cercas (Hospital de Jerez, Cádiz); A. Nebra (Hospital Clínico Universitario, Zaragoza); C. Castillo (Hospital Txagorritxu, Vitoria), A. Tejada (UCI Traumatología, Hospital Miguel Servet, Zaragoza) and J.I. Gómez (REA, Hospital Río Ortega, Valladolid), Spain.

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Álvarez-Lerma, F., Nolla-Salas, J., León, C. et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med 29, 1069–1076 (2003).

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