Association Between Candiduria and Candidemia: A Clinical and Molecular Analysis of Cases

Abstract

The risk of developing candidemia after candiduria is reportedly very low, but it has not been adequately investigated. The aim of this study was to examine the molecular relatedness between Candida strains isolated from adult patients with candidemia and concomitant candiduria in association with the clinical characteristics of the cases. All episodes of candidemia occurring in a tertiary care academic hospital during a 5-year period were recorded prospectively. Patients with episodes of candiduria occurring two weeks preceding to or one week following a positive for Candida blood culture were included in the study. The genotypic relatedness of Candida strains isolated from blood and urine was investigated by pulsed-field gel electrophoresis after digestion with the BssHII restriction endonuclease. We recorded 141 candidemia episodes, occurring in 134 patients. Twelve episodes of candidemia with concomitant candiduria occurred in 11 patients (8% of all candidemias). In six of these episodes, the strains in the blood-urine pairs belonged to different species. In two episodes, the isolates belonged to the same species but were not genetically related, and only in four (2.8% of all candidemias), the strains were related. All four patients were severely ill and had multiple risk factors for candidemia. These findings indicate that in hospitalized patients with candidemia, concomitant candiduria is rare and usually an independent event, confirming previous reports. In the critically ill, however, the existence of genetically related strains in blood and urine appears to be more frequent, with more probable the hematogenous dissemination.

The Impact of 2015 NHSN Catheter-associated Urinary Tract Infection (CAUTI) Definition Change on Central Line-associated Bloodstream Infection (CLABSI) Rates and CLABSI Prevention Efforts at an Academic Medical Center

“…However, candiduria is rarely clinically significant. Drogari-Apiranthitou et al 11 conducted a 5-year clinical and molecular analysis of cases with candidemia and candiduria and found that concomitant candiduria is rare in hospitalized patients with candidemia, confirming previous reports. Hence, the 2015 NHSN definition change has likely led to a more appropriate attribution of catheter-related candidemia by excluding CAUTI as a potential source.…”

Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria

“…While candiduria is highly prevalent in hospitalised patients, the presence of concomitant candidaemia is infrequently encountered. 1,4 Our study revealed that out of the 4240 patients with candiduria, only 263 cases (6.2%) had concomitant candidaemia.…”

“…Candiduria is a frequent finding amongst hospitalised patients with a global incidence rate of 27.4 per 1000 patient admissions . The presence of yeast in the urine commonly represents benign colonisation of the urinary tract or perineum, but can also be a sentinel of a haematogenous infection .…”

“…Candiduria is a frequent finding amongst hospitalised patients with a global incidence rate of 27.4 per 1000 patient admissions. 1,2 The presence of yeast in the urine commonly represents benign colonisation of the urinary tract or perineum, but can also be a sentinel of a haematogenous infection. [3][4][5] Candidaemia, the most common form of invasive candidiasis, is associated with an attributable mortality rate of 38%-49% and is responsible for prolonged hospital stays and high healthcare expenditure.…”

Peer Review #3 of "Candiduria in hospitalized patients: an investigation with the Sysmex UF-1000i urine analyzer (v0.1)"

“…Numerous studies in experimental animals and clinical observations have indicated that the kidney consistently acts as the main fungus-bearing organ during candida infection [3][4][5]. In severely ill patients, candiduria has been considered to be significantly associated with disseminated candidiasis [6][7][8]. In surgical intensive care unit (ICU) settings, candiduria has been proved to be an independent factor associated with mortality [9].…”