Candiduria in catheterized ICU patients: epidemiology, molecular identification, and antifungal susceptibility

Ali Ahmadi; Ebrahim Hazrati; Mahtab Noorifard; Zohreh Farahnejad; Mojgan Mohammadimehr

doi:10.18502/ijm.v18i1.20939

Ali Ahmadi Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran
Ebrahim Hazrati Department of Anesthesiology and Critical Care and Trauma Research Center, AJA University of Medical Sciences, Tehran, Iran
Mahtab Noorifard Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran
Zohreh Farahnejad Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran
Mojgan Mohammadimehr Infectious Disease Research Center, AJA University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v18i1.20939

Keywords: Candida; Urinary catheters; Drug resistance; Intensive care unit

Abstract

Background and Objectives: Candiduria related to urinary catheters is frequently encountered in patients hospitalized in intensive care units. The diagnosis and management of catheter-associated candiduria in hospitalized patients is frequently a gray area for both physicians and microbiologists because of the paucity of clinical and microbiological data.

Materials and Methods: This cross-sectional study aims to enhance the understanding of candiduria among adult ICU patients with urinary catheters across three hospitals in Tehran, Iran. Yeast identification was performed us- ing a two-step multiplex PCR, and antifungal susceptibility testing was performed following the CLSI M27, 4th edition, recommendations.

Results: Among the 110 enrolled ICU patients, 38 (35%) had significant candiduria. A total of 45 yeast isolates were col- lected. The distribution was as follows: Candida glabrata (23/45; 51%), C. albicans (14/45; 31%), and C. tropicalis (4/45; 9%). These three species accounted for 91% of the isolates. Antifungal resistance was detected: six isolates (two C. glabrata, two C. albicans, one C. krusei, and one C. tropicalis) were fluconazole-resistant, and one C. glabrata isolate was resistant to itraconazole, voriconazole, and caspofungin. All isolated species were susceptible to amphotericin B. Symptomatic can- diduria occurred in 29% of cases (11/38); only 55% (6/11) were treated, and of those, 50% (3/6) experienced fluconazole treatment failure. One symptomatic patient developed candidemia shortly after acquiring candiduria. The mortality rate was 21% (8/38), with no apparent difference in death rates between symptomatic and asymptomatic candiduric patients.

Conclusion: Our findings reveal that high fluconazole failure rates among patients with symptomatic candiduria are concern- ing. Furthermore, speciation and antifungal susceptibility testing are crucial, as they guide clinicians in selecting the most effective agent and improving case management.