Characteristics and Clinical Relevance of Candiduria in Hospitalized Patients

TL;DR

This study examines candiduria in hospitalized patients, focusing on risk factors, treatment patterns, and outcomes.

Contribution

The study provides insights into the clinical relevance and characteristics of candiduria in a regional hospital setting.

Findings

Nakaseomyces glabratus was the most frequently isolated Candida species.

Most patients had comorbidities, urinary catheters, and prior antibiotic use.

Fewer than half of candiduria cases presented clinical symptoms.

Abstract

Background: Candiduria is a common finding in hospitalized patients, particularly in intensive care units (ICUs) and in those with indwelling urinary catheters. Additionally, Candida spp. is among the most frequent causes of healthcare-associated urinary tract infections and can lead to severe clinical manifestations in specific scenarios involving risk factors. Objective: The objective of this study is to describe and analyze the epidemiological features, clinical risk factors, therapeutic approaches, and clinical outcomes in a cohort of hospitalized patients with candiduria at a regional hospital. Methods: This was a retrospective, descriptive, cross-sectional study based on the selection of 207 urine cultures positive for Candida spp. between 1 February 2024, and 31 August 2024, at the Microbiology Laboratory of the Virgen de las Nieves University Hospital in Granada, Spain. Results: The most frequently isolated species was Nakaseomyces glabratus (42.03%), with no sex differences and a predominant occurrence in ICU patients (36.71%). Most patients had comorbidities (86.47%), urinary catheters (72.46%), and prior antibiotic use (75.85%). Less than half of the cases presented clinical symptoms (41.55%). Antifungal therapy was administered in 38.65% of cases, predominantly fluconazole (61/207; 29.47%), followed by echinocandins (12/207; 5.8%). Use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) was documented in 36.71% of patients. Conclusions: Candiduria is more frequently observed in elderly patients with multiple comorbidities, ICU admission, indwelling urinary catheters, prior antibiotic therapy, and SGLT2i use. Fewer than half of the episodes are symptomatic. Non-albicans yeast species, which often display distinct resistance patterns, are increasingly prevalent, with N. glabratus being the most frequently isolated.