Infecção do trato urinário por leveduras do gênero Candida ­ revisão de literatura / Urinary tract infection by yeast of the genus Candida - literature review / Infección del tracto urinario causada por levaduras del género Candida - revisión de la literatura

A ocorrência das infecções do trato urinário (ITU) causadas por leveduras do gênero Candida estão aumentando consideravelmente nas últimas décadas, sendo a Candida albicans a mais comumente diagnosticada como causadora deste tipo de infecções. Contudo, outras espécies, como exemplo da Candida tropicalis, estão emergindo como preocupantes causadores da doença. Neste sentido, o objetivo do presente trabalho é revisar os aspectos relacionados com as ITU causadas por leveduras do gênero Candida. Foi realizada uma pesquisa na base de dados PubMed, buscando artigos sobre a epidemiologia, patogenia e tratamento das ITU causadas por leveduras do gênero Candida. As espécies de Candida são os fungos patogênicos oportunistas mais relevantes causadores de infecções nosocomiais e podem causar infecção no trato urinário, tanto inferior (ureteres, bexiga e uretra) quanto superior (rins), principalmente em pacientes imunocomprometidos. Existem alguns fatores predisponentes, como gênero feminino, idade avançada, diabetes mellitus, hospitalização prolongada, imunossupressão, gravidez, hipertensão, neutropenia, cálculos renais, infecções nosocomiais, terapia antibiótica e procedimentos, como a cateterização, que atuam como facilitadores das ITU por Candida spp. A doença pode ocorrer de forma assintomática, porém, pode evoluir para casos mais graves com comprometimento sistêmico em situações de candidemia que pode causar a morte do paciente, principalmente se tratando de indivíduos imunocomprometidos. Sendo assim, devido ao risco existente, a doença não pode ser negligenciada e um diagnóstico preciso e um tratamento adequado devem ser estabelecidos.

The occurrence of urinary tract infections (UTI) caused by yeasts of the genus Candida has increased considerably in recent decades, with Candida albicans being the most commonly diagnosed as causing this type of infections. However, other species, such as Candida tropicalis, are emerging as worrisome causes of the disease. In this sense, the objective of the present paper is to review the aspects related to the UTI caused by yeasts of the genus Candida. A search was carried out in the PubMed database, searching for articles on the epidemiology, pathogenesis and treatment of UTI caused by yeasts of the genus Candida. Candida species are the most relevant opportunistic pathogenic fungi that cause nosocomial infections and can cause both lower (ureters, bladder and urethra) and upper (kidneys) urinary tract infections, especially in immunocompromised patients. There are some predisposing factors, such as female gender, advanced age, diabetes mellitus, prolonged hospitalization, immunosuppression, pregnancy, hypertension, neutropenia, kidney stones, nosocomial infections, antibiotic therapy and procedures, such as catheterization, that act as facilitators of UTI by Candida spp. The disease can occur asymptomatically, however, it can progress to more severe cases with systemic involvement in situations of candidemia that can cause the death of the patient, especially in immunocompromised individuals. Therefore, due to the existing risk, the disease cannot be neglected and an accurate diagnosis and adequate treatment must be established.

La aparición de infecciones del tracto urinario (ITU) causadas por levaduras del género Candida ha aumentado considerablemente en las últimas décadas. Candida albicans es la infección por levaduras más comúnmente diagnosticada. Sin embargo, otras especies, como la Candida tropicalis, están surgiendo como causa preocupante de la enfermedad. En este sentido, el objetivo del presente trabajo es revisar los aspectos relacionados con la ITU causada por levaduras del género Candida. Se realizó una búsqueda en la base de datos PubMed, buscando artículos sobre la epidemiología, la patogénesis y el tratamiento de la ITU causada por levaduras del género Candida. Las especies de Candida son los hongos patógenos oportunistas más relevantes que causan infecciones nosocomiales y pueden provocar infecciones del tracto urinario inferior (uréteres, vejiga y uretra) y superior (riñones), especialmente en pacientes inmunodeprimidos. Existen algunos factores predisponentes, como el sexo femenino, la edad avanzada, la diabetes mellitus, la hospitalización prolongada, la inmunosupresión, el embarazo, la hipertensión, la neutropenia, los cálculos renales, las infecciones nosocomiales, la terapia con antibióticos y los procedimientos como el cateterismo, que actúan como facilitadores de la ITU por Candida spp. La enfermedad puede presentarse de forma asintomática, pero puede evolucionar a casos más graves con afectación sistémica en situaciones de candidemia que pueden causar la muerte del paciente, especialmente en individuos inmunodeprimidos. Por lo tanto, debido al riesgo existente, no se puede descuidar la enfermedad y se debe establecer un diagnóstico preciso y un tratamiento adecuado.

Utility of Urine KOH in Detecting Candiduria in Infants

Background@#Candida species are common cause of urinary tract infection in infants requiring medical care. Candida fungal elements may be demonstrated in urine using microscopic examination with potassium hydroxide (KOH). However, detection of these elements does not always correlate with candiduria. @*Objectives@#To establish the utility of urine KOH in identifying candiduria and to determine the risk factors, as well as urinalysis and CBC parameters associated with candiduria. @*Methods@#This prospective cross-sectional study included admitted infants 1 year and below with urine culture and with any risk factor/s for candiduria. Additional urine KOH testing was done using clean catch or catheter method. Urine culture was used as the gold standard. @*Results@#Among the 90 study participants with both urine culture and urine KOH, 13 (14%) had candiduria. The use of indwelling catheter, presence of urinary tract anomalies, positive leukocyte esterase in urinalysis, and increased monocyte counts in CBC are all associated with candiduria. Urine KOH has sensitivity of 100%, (CI 75.2-100%), specificity 59.7%, (CI 47.9-70.7%), PPV 29.5%, (CI 17.7-45.2%), and NPV 100%, (CI 92.2-100%) in detecting candiduria.@*Conclusions@#Negative urine KOH has excellent negative predictive value, while positive urine KOH result may warrant further investigation. Urine KOH results should be interpreted with caution depending on patient’s risk factors, clinical status, and other laboratory results prior to initiation of empiric antifungal therapy. Positive urine KOH may not always require treatment.

Candiduria: A Reliable Indicator Of Neonatal Candidemia ? An Experience In A Tertiary Care Hospital.

Background & Objectives: Candidemia is a significant cause of nosocomial mortality and morbidity in neonates. Prompt diagnosis and treatment is crucial. Non-albicans Candida (NAC) species are assuming an increasing role in nosocomial infections in neonates. The present study was carried out i) to identify and speciate the Candida isolates obtained from cases of neonatal candidemia and to assess the risk factors and clinical manifestations associated with it (ii) to evaluate if candiduria, can be considered as a reliable indicator of candidemia. Methods: The prospective cohort study included the blood samples from 527 clinically suspected cases of neonatal septicaemia which were subjected to automated culture and processed as per standard microbiological techniques. The urine samples from all the 527 neonates were processed by conventional method. Results: Frequency of neonatal candidemia in culture proven cases of septicemia was 30.1%. Low birth weight was the commonest risk factor, followed by prematurity. Non-albicans Candida (NAC) species were isolated from blood in 86.4% cases compared to Candida albicans in 13.6%. Candida glabrata was the predominant species. Overall, candiduria was found in 54.5% cases of neonatal candidemia with same species of Candida isolated both from blood and urine samples. Among the cases of candiduria, NAC species were isolated in 81.7% compared to C. albicans in 18.3%. Correlation between candiduria and candidemia was maximum (73.33%) in C. albicans followed by C. tropicalis (72.41%) and C. glabrata (55.81%). Conclusions: The present study highlights the emergence of NAC species as an important cause of neonatal candidemia from Meerut city: definitely a changing trend. Further, our study also highlights that candiduria may be considered as a reliable indicator of candidemia in neonates.

Fungoma vesical por Candida tropicalis: un caso clínico pediátrico / Bladder fungus ball by Candida tropicalis: a pediatric case report

Vesical fungus ball is a mobile, oval and echogenic mass as a result of accumulation of long and wide numerous hyphae. Fungal urinary tract infection incidence has increased notoriously and there are isolated yeast in 7 to 8% of urine cultures. Different species of Candida are cause of urinary tract infection. Epidemiologically, the first isolated pathogen is Candida albicans, followed by Candida tropicalis. Bladder poll has been documented as the most important risk factor for candiduria in critical patients into intensive care.

Un fungoma vesical es una masa móvil, oval y ecogénica en la vejiga resultante del acúmulo de hifas largas y anchas. La incidencia de la infección urinaria de etiología fúngica se ha incrementado notablemente. Se aíslan levaduras en 7 a 8% de los urocultivos. Diferentes especies de Candida son causantes de infección urinaria, siendo Candida albicans la más frecuente, seguida de Candida tropicalis. Presentamos el caso de un niño varón de cuatro años, con un síndrome de Guillain Barré, catéter urinario permanente, estadía prolongada en UCI y expuesto a tratamiento antibacteriano de amplio espectro que desarrolló un fungoma vesical, diagnosticado por ecotomografía, con aislamiento de C. tropicalis en orina. Se trató con anfotericina B deoxicolato y extracción del fungoma por cistoscopia, con buena respuesta clínica. El cateterismo vesical se ha documentado como el factor de riesgo más importante para candiduria en pacientes de terapia intensiva.

Non-Albicans Candiduria: An Emerging Threat.

Objective: The incidence of Candida has been on rise worldwide. Clinicians face dilemma in differentiating colonization from true candiduria. The species identification of Candida is important, as non albicans Candida species are increasing in number and more resistant to antifungal drugs. Material and methods: The present study was conducted at a tertiary care teaching hospital of North India with an aim of investigating prevalence of NAC spp. among Candida isolates from urinary tract specimens. Results: A total of 7627 urine samples were analysed in a tertiary care hospital. The Candida isolates (180) were further speciated by Gram stain, culture on sabouraud’s dextrose agar, germ tube test, sugar fermentation test. A total of 180 (2.36%) Candida species were isolated from 7627 urine samples. Among them non albicans Candida species were predominant (66.7%), compared to Candida albicans(33.3%).The rate of isolates of Candida species were more in females, 101 (56.1%) than in males 79 (43.9%). The highest isolation rates of Candida among uropathogens were found in age group above 60 years.The emergence of non-albicans Candida similar to the trends in the western countries should be a cause of concern in our country. Conclusions: NAC spp. have emerged as an important cause of urinary tract infections. Its isolation from clinical specimens can no longer be ignored as nonpathogenic isolate nor can it be dismissed as a contaminant. Proper surveillance of these fungal pathogens is important to improve quality of care in tertiary care setting.

Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Menoufia University Hospitals, Egypt.

Aims: Detect the incidence of urinary tract infection caused by candida species and to determine their antifungal susceptibility, biofilm formation and its minimal biofilm inhibitory concentration. In addition, detect the importance of multiplex nested polymerase chain reaction (PCR) in detection of candidemia in serum of patients with candidurea. Methodology: Study was carried out by collecting urine samples from 200 patients admitted in the intensive care unit inMenoufia university hospitals and suspected to have hospital acquired urinary tract infection. Isolation, identification and antifungal susceptibility testing were done. Biofilm formation and Minimum biofilm inhibitory concentration testing were detected. Patients with positive candiduria were tested for the presence of candida in serum by multiplex nested PCR. Results: Candida spp. were isolated from urine of 38(19%) patients, 78.9% of them were catheterized, C. albicans was isolated from 18(47.3%) samples as detected by Analytical profile index (API system). Antifungal susceptibility show that Flucytosmine, Amphotericin B, Voriconazole were more effective antifungal agents against Candida spp (100%, 84.2% and 84.2% respectively). A total of 26 (%68.4) out of 38 Candida species isolates produced biofilm. 72.2% of the tested C. albicans, were resistant to fluconazole and had MBIC > 640 μg/mL while only 27.8% were sensitive to fluconazole and had MBIC < 10 μg/mL. 26.3% out of 38 patients with candiduria had candidaemia as detected by multiplex nested CR. Conclusion: Candida albicans is the most common Candida spp that show biofilm production. There is increased in the percentage of the resistance to fluconazole in candida isolates in this study. The incidence of candidemia among patients with candidurea was high in our study.

Fungal profile of funguria cases at a tertiary care hospital in southern India.

Background & objectives: Candida albicans is the most common aetiological agent in funguria cases commonly observed in hospitalized patients. But a few reports are available from India where non-albicans Candida species have accounted for >50 per cent of urinary Candida isolates. We undertook this study to know the fungal profile amongst funguria cases. Methods: A total of 123 consecutive fungal isolates obtained from clinically suspected cases of urinary tract infection from April to September, 2013, were included. Yeast species was identified by standard phenotypic methods. Antifungal susceptibility testing of yeast was performed for fluconazole (25 μg) by disc diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The male to female ratio was 0.92. The mean age of patients was 42.7 ± 18.9 yr. C. tropicalis (58.5%) was the most common fungal agent followed by C. albicans (30.1%). Only one isolate of C. tropicalis was resistant to fluconazole. Interpretation & conclusions: C. tropicalis and C. albicans were the predominant fungal pathogens responsible for urinary tract infection. Less resistance to fluconazole observed in the study may be due to restricted use of fluconazole in this area.

Candidúria em adultos e crianças: prevalência e suscetibilidade a antifúngicos em pacientes ambulatoriais de Jataí-GO / Candiduria in adults and children: prevalence and antifungal susceptibility in outpatient of Jataí-GO

Introduction: The term candiduria refers to the presence of yeast in urine and Candida albicans is the most common agent. In general, routine laboratories do not perform identification and cultivation of yeast. Objectives: To determine the prevalence of Candida species and to evaluate the antifungal susceptibility of the species isolated in urine of outpatients Jataí-GO, between January-October 2013. Material and method: Urine samples containing fungal structures were plated out on Sabouraud agar with chloramphenicol. Differentiation was taken with the urease test, nitrogen and carbon sources assimilation, germ tube test, morphology on cornmeal agar and chromogenic agar cultivation. Susceptibility was evaluated at antifungal itraconazole, fluconazole, amphotericin B and ketoconazole. Results: 1,215 urine tests were performed, and 64 had fungal structures (5.3%). Two samples were lost, thus here we considered 62 isolates. From this total, 43 were identified as C. albicans (67.2 %), eight C. glabrata (12.5 %), five C. krusei (7.8%), three C. tropicalis (4.7%), and three could not determine the species (4.7%). Amphotericin B and ketoconazole inhibited 94.9% of the isolates. On the other hand, 55.9% and 54.2 % were resistant to itraconazole and fluconazole, respectively. The resistance rates of both fluconazole and itraconazole for C. glabrata and C. albicans, as fluconazole for C. albicans and C. krusei, showed significant differences (p < 0.05). Conclusion: These data demonstrate the importance of conducting a full identification and susceptibility to antifungal agents in samples with yeast infection...

Introdução: O termo candidúria designa a presença de leveduras na urina e Candida albicans é o agente mais comum. Em geral, os laboratórios de rotina não realizam o cultivo e a identificação da levedura. Objetivos: Determinar a prevalência de espécies de Candida e avaliar o perfil de sensibilidade aos antifúngicos das espécies isoladas em urina de pacientes ambulatoriais do município de Jataí-GO, entre janeiro e outubro de 2013. Material e método: Amostras de urina que continham estruturas fúngicas foram semeadas em ágar Sabouraud com cloranfenicol. A diferenciação foi feita com provas da urease, assimilação de fontes de nitrogênio e carbono, tubo germinativo, morfologia em ágar fubá e cultivo em ágar cromogênico. Foi avaliada a sensibilidade aos antifúngicos itraconazol, fluconazol, anfotericina B e cetoconazol. Resultados: Foram realizados 1.215 exames de urina, sendo que 64 apresentaram estruturas fúngicas (5,3%). Houve perda de duas amostras, assim, considerou-se 62 isolados. Desse total, 43 foram identificadas como C. albicans (67,2%); oito, C. glabrata (12,5%); cinco, C. krusei (7,8%); três, C. tropicalis (4,7%); e em três não foi possível determinar a espécie (4,7%). Anfotericina B e cetoconazol inibiram 94,9% dos isolados. Por outro lado, 55,9% e 54,2%, respectivamente, apresentaram resistência a itraconazol e fluconazol. As taxas de resistência a itraconazol e fluconazol de C. glabrata e C. albicans e também do fluconazol entre C. albicans e C. krusei apresentaram diferenças significativas (p < 0,05). Conclusão: Os dados demonstram a importância de se realizar a identificação completa e também o antifungigrama para amostras que apresentam infecção por leveduras...

Hibiscus sabdariffa extract inhibits in vitro biofilm formation capacity of Candida albicans isolated from recurrent urinary tract infections

<p><b>OBJECTIVE</b>To explore the prevention of recurrent candiduria using natural based approaches and to study the antimicrobial effect of Hibiscus sabdariffa (H. sabdariffa) extract and the biofilm forming capacity of Candida albicans strains in the present of the H. sabdariffa extract.</p><p><b>METHODS</b>In this particular study, six strains of fluconazole resistant Candida albicans isolated from recurrent candiduria were used. The susceptibility of fungal isolates, time-kill curves and biofilm forming capacity in the present of the H. sabdariffa extract were determined.</p><p><b>RESULTS</b>Various levels minimum inhibitory concentration of the extract were observed against all the isolates. Minimum inhibitory concentration values ranged from 0.5 to 2.0 mg/mL. Time-kill experiment demonstrated that the effect was fungistatic. The biofilm inhibition assay results showed that H. sabdariffa extract inhibited biofilm production of all the isolates.</p><p><b>CONCLUSIONS</b>The results of the study support the potential effect of H. sabdariffa extract for preventing recurrent candiduria and emphasize the significance of the plant extract approach as a potential antifungal agent.</p>

Antifungal susceptibility and distribution of Candida spp. isolates from the University Hospital in the municipality of Dourados, State of Mato Grosso do Sul, Brazil

Introduction Hospital infections caused by Candida spp. are a leading cause of morbidity and mortality in hospitalized patients, particularly those that are critically ill or immunocompromised. In this study, the distribution of Candida species in isolates from the University Hospital of the Federal University at Grande Dourados and their in vitro susceptibility to antifungal drugs were analyzed. Methods Yeasts were phenotypically identified using classical methodologies. Antifungal susceptibility tests to amphotericin B and fluconazole were performed using the broth microdilution technique. Results A total of 50 Candida isolates were obtained from hospitalized patients during the study period. We analyzed yeast isolates from urine (n=31; 62%), blood (n=12; 24%), and tracheal secretions (n=7; 14%). The following Candida species were identified: C. tropicalis (n=21; 42%), C. albicans (n=18; 36%), C. glabrata (n=10; 20%), and C. krusei (n=1; 2%). Antifungal susceptibility tests demonstrated that C. albicans was susceptible to both antifungal agents. However, 31.2% of the non-C. albicans Candida isolates displayed dose-dependent susceptibility to fluconazole, and 3.1% were resistant to amphotericin B. Conclusions In contrast to previous reports, our results indicated that C. tropicalis was the most commonly isolated yeast species among the hospital patients. The predominance of non-C. albicans Candida infections confirms the importance of species-level identification for implementing appropriate antifungal therapies. .

Candiduria in catheterized intensive care unit patients : Emerging microbiological trends.

Objectives: Urinary tract infection (UTI) as a result of Candida spp. is becoming increasingly common in hospitalized setting. Clinicians face dilemma in differentiating colonization from true infection and whether to treat candiduria or not. The objective of the present study was to look into the significance of candiduria in catheterized patients admitted in the ICUs and perform microbiological characterization of yeasts to guide treatment protocols. Materials and Methods: One hundred consecutive isolates of Candida spp. from the urine sample of 70 catheterized patients admitted in the ICU were collected and stocked for further characterization. A proforma was maintained containing demographic and clinical details. Blood cultures were obtained from all these 70 patients and processed. Species identification of yeasts was done on VITEK. Results: Candiduria was more common at extremes of age. The mean duration of catheter days was 11.1 ± 6 days. Other associated risk factors such as diabetes mellitus and antibiotic usage were seen in 38% and 100% of our study group. Concomitant candidemia was seen in 4.3% of cases. Non-albicans Candida spp. (71.4%) emerged as the predominant pathogen causing nosocomial UTI. Conclusion: The present study reiterates the presence of candiduria in catheterized patients, especially in the presence of diabetes and antibiotic usage. Non-albicans Candida spp. are replacing Candida albicans as the predominant pathogen for nosocomial UTI. Hence, we believe that surveillance for nosocomial candiduria should be carried out in hospitalized patients.

Candiduria nosocomial: etiología y prevalencia de sus agentes causales en el Hospital Paroissien / Nosocomial candiduria: Etiology and prevalence of its causal agents in Paroissien Hospital

Se evaluó retrospectivamente la etiología y evolución de la frecuencia de los agentes causales de candiduria, en 300 episodios ocurridos en pacientes internados en el Hospital Paroissien, entre el 21 de enero de 2000 y el 30 de diciembre de 2009. Fueron diagnosticados 33 (11,0%) episodios en 2000, 26 (8,7%) en 2001, 34 (11,3%) en 2002, 20 (6,7%) en 2003, 30 (10,0%) en 2004, 25 (8,3%) en 2005, 47 (15,7%) en 2006, 27 (9,0%) en 2007, 33 (11,0%) en 2008 y 25 (8,3%) en 2009. Candida tropicalis, C. albicans, C. glabrata y C. parapsilosis prevalecieron en orden descendente de frecuencia y C. guillermondii, C. krusei y C. lusitaniae se aislaron excepcionalmente. C. tropicalis prevaleció entre 2000-2002, 2004-2006 y en 2008, seguida por C. albicans, que fue la más prevalente en 2003, 2007 y 2009. C. glabrata ocupó el segundo lugar en 2000, 2004 y 2006 y el tercero en los demás años, salvo en 2001, 2008 y 2009, cuando fue desplazada por C. parapsilosis, que en 2009 ocupó el primer lugar junto con C. albicans. Los resultados obtenidos confirman el predominio de las especies de Candida no- albicans como agentes causales de candiduria en la población estudiada, particularmente C. tropicalis, desde 2003, que podría mantenerse actualmente. La ausencia de datos previos impidió discernir si los patrones hallados son recientes o se mantuvieron a través del tiempo.

The present study carried out a retrospective evaluation of the etiology and evolution of the frequency of the causal agents of 300 candiduria events diagnosed in patients assisted at the Paroissien Hospital from 2 January 2000 to 30 December 2009. A total of 33 (11.0%) episodes were dioagnosed in 2000, 26 (8.7%) in 2001, 34 (11.3%) in 2002, 20 (6.7%) in 2003, 30 (10.0%) in 2004, 25 (8.3%) in 2005, 47 (15.7%) in 2006, 27 (9.0%) in 2007, 33 (11.0%) in 2008 and 25 ( 8.3%) in 2009. C. tropicalis, C. albicans, C. glabrata y C. parapsilosis were, in descendent order, the most frequent species involved, with C. guillermondii, C. krusei and C. lusitaniae only exceptionally isolated. C. tropicalis was the most prevalent between 2000-2002, 2004-2006 and in 2008, followed by C. albicans, which was the most prevalent in 2003, 2007 and 2009. C. glabrata was the second species in 2000, 2004 y 2006 and the third in the remaining years studied, except for 2001, 2008 and 2009 when it was displaced by C. Parapsilosis, which held the first place in 2009, along with C. albicans. The results obtained confirm the predominance of the Candida no - albicans species as etiological agents of candiduria in the popularion under study, particularly C. tropicalis, from 2003 onwards, possibly until nowadays. However, due to the lack of previous studies on the subject, it was impossible to determine if the patterns observed are only recent or if they have remained unaltered for longer periods of time.

Identificação e perfil de sensibilidade de Candida spp isoladas de urina de pacientes com Candidúria em Iguatu-Ceará / Identification and profile of sensitivity of isolated Candida spp of urine of patients with Candiduria in Iguatu-Ceará

O estudo foi realizado para idntificar e avaliar a sensibilidade de Candida spp isoladas em amostras de urina de pacientes com infecção urinária no município de Iguatu - Ceará. Foram identificadas 24 amostras 45% eram C. albicans, 21% C. parapsilosis, 13% C. tropicallis e 21% Candida spp. C. albicans ainda é a espécie de Candida mais encontrada em urina, mas observa-se o aumento de outras espécies de Candida spp.

A clinical and etiological analysis of candida urinary tract infections in intensive care unit / 中国医师进修杂志

Objective To investigate the clinical characteristics, risk factors and pathogenic disposition of candida urinary tract infections in intensive care unit(ICU)patients. Methods A retrospective review and analysis of clinical information and urine culture of 83 ICU patients with the candida urinary tract infections. Results All patients had severe underlying diseases one or more complication and/or concomitant diseases were existed at the same time. All of the patients previously used broad-spectrum antibiotics and received invasion in diagnosis and therapy: indwelling urinary catheters, mechanical ventilation, incision of trachea, deep artery or vein operation with catheters indwelling, surgical operation and indwelling drainage tube (96.39%, 95.18%, 69.89%, 46.99%, 43.37%, 33.73%, respectively). In all the patients, 62.65% patients were elder. Hospitalization days of 54.22% patients staying in ICU were above 31 days. Mortality rate was in 39.76%( 33 cases ). C.tropicalis(55.91%) and C.albicans(35.48%) were the major pathogens. Seventy-four cases( 89.16%)were infected by one candida specie, and 9 cases( 10.84% )were infected by two or three candida species. The positive blood culture was found in 9 cases ( 10.84% ) also. Conclusions The ICU patients with severe underlying diseases and high risk factors may have candida urinary tract infections easily. C.tropicalis and C.albicans are the most common pathogens. Some candiduria is the evidence of candidemia.

Epidemiology and Management of Candiduria / 대한의진균학회지

Candiduria is often observed in hospitalized patients. Candiduria is neither a symptom nor a sign, and it is not a disease definitly. Yeasts in urine can be detected in patients who have bladder colonization, and in patients who have upper urinary tract infection that developed either from ascending infection or hematogenous spread. Unfortunately, there are no diagnostic methods that reliably distinguish infection from colonization. Asymptomatic nosocomial candiduria does not frequently require treatment intervention, because morbidity is low and ascending infection and candidemia aer rare complications. Although there is a guideline actually for treatment of candiduria has been suggested by Infectious diseases Society of America, it was based almost on expert opinions and experience rather than controlled clinical trials. For candida cystitis, the first-line treatment is oral fluconazole and ascending pyelonephritis usually requires the administration of systemic antifungal agents with or without correction of the obstruction or surgical intervention.

Candiduria in a public hospital of São Paulo (1999-2004): characteristics of the yeast isolates

The study involved 100 yeast isolates, obtained from urine samples provided by a Public Pediatric Hospital of São Paulo, Brazil, from 1999 to 2004. The most frequent species was Candida albicans, followed by C. tropicalis, C. glabrata and C. parapsilosis. In regard to virulence, 97 percent of the isolates showed index 3 for proteinase and 63 percent index 2 for phospholipase. The most frequent killer biotypes were 511 and 888.

Estudou-se 100 amostras de leveduras, isoladas de urina, provenientes de Hospital Público Infantil de São Paulo Brasil, no período de 1999-2004. A espécie mais freqüente foi Candida albicans, seguida de C. tropicalis, C. glabrata e C. parapsilosis. Em relação à virulência, 97 por cento dos isolados apresentaram índice 3 para proteinase e, 63 por cento índice 2 para fosfolipase. Os biótipos "killer" mais freqüentes foram o 511 e 888.

Candidúria: uma abordagem clínica e terapêutica / Candiduria: a clinical and therapeutic approach

O achado laboratorial de candidúria traz dilemas em relação a sua interpretação visto que pode refletir uma amplitude de possibilidades clínicas, incluindo colonização, infecção urinária alta ou doença sistêmica por Candida spp. Neste artigo, abordaremos a epidemiologia, o diagnóstico e a terapêutica da candidúria em diversos cenários clínicos, incluindo pacientes transplantados renais. De forma prática e para efeito de abordagem terapêutica, a interpretação do achado de candidúria é baseada na presença de dados clínicos e epidemiológicos Quando necessária, a terapêutica antifúngica para os casos de candidúria pode ser realizada com: anfotericina B sistêmica, anfotericina B tópica (irrigação vesical) ou fluconazol. A coleta de hemoculturas deve ser indicada em pacientes com candidúria sob risco para desenvolvimento de candidíase hematogênica. A retirada da sonda vesical de demora deve ser considerada sempre que possível, pois reduz a possibilidade de persistência ou recorrência da infecção urinária por Candida spp.

Candiduria remains a controversial issue for clinicians once that it may represent a broad variety of possibilities including colonization, local or systemic infection. We will discuss the epidemiology, diagnosis and treatment of candiduria in different settings of patients, including renal transplant recipients. Definitions on therapy are mostly based on epidemiological and clinical data. Once antifungal therapy is required the following antifungal treatment may be used: intravenous amphotericin B, bladder irrigation with amphotericin B or fluconazole. Blood cultures may be required in patients with candiduria and high risk for developing hematogenous infection. Removal of the urinary catheter must be considered in order to avoid persistent candiduria and recurrence.

The new progress in diagnoses and therapy of Candiduria / 中国实用内科杂志

Since the current diagnostic techniques difficult to accurately distinguish the source of uric candidas between colonization and infection,making the clinical status and the value of diagnosis and treatment of candiduria were not given sufficient attention.This paper analyzes research and case reports of cadiduria both home and abroad,and the results showed that there is a close relationship between candiduria and candidemia,and candiduria has more easier initiated the invasive candidiasis than other sites colonization of candidas.So it is worth to give more clinical attention,especially for critical patients,and should be active in antifungal therapy after identified the cause of candiduria.

Molecular Typing of Urinary Isolates of Candida tropicalis by Pulsed-Field Gel Electrophoresis (PFGE) and Random Amplified Polymorphic DNA (RAPD) Analysis / 감염

BACKGROUND: Despite the recognized increase of frequency of candiduria due to Candida tropicalis, little was known of its molecular epidemiology. We applied PFGE and RAPD assay for urinary C. tropicalis isolates and evaluated the utilities of PFGE and RAPD for the epidemiological typing of C. tropicalis isolates. METHODS: A total of urinary 57 isolates of C. tropicalis from 40 patients at two hospitals was analyzed. PFGE analysis were performed by electrophoretic karyotyping (EK) and restriction endonuclease analysis of genomic DNA (REAG) using two restriction enzymes (BssHII and SfiI). For RAPD, a total of 31 primers (30 random 10-mer primers and M13 primer) were used. RESULTS: EK and RAPD analysis showed the same or similar patterns among the isolates. REAG with BssHII separated 57 isolates into 28 distinct types. Six patterns were generated by REAG with using SfiI. By combining the two REAG, a total of 31 different DNA types were identified among 57 isolates from 40 patients. Three strain types were common to 23 isolates from 12 patients of a University Hospital, which suggested possible nosocomial transmission. In 19 patients with serial urinary isolates, the sequential strains from each patient exhibited the same REAG pattern. CONCLUSION: These suggest that REAG with BssHII and SfiI is useful for the investigation of molecular epidemiology of C. tropicalis isolates. In addition, some clusters of C. tropicalis isolates with the same DNA type suggest that nosocomial transmission may occur.

Continuous Bladder Irrigation with Amphotericin B versus Oral Administration of Fluconazole in Patients with Candiduria / 대한비뇨기과학회지

PURPOSE: The efficacy of continuous bladder irrigation with amphotericin B versus oral administration of fluconazole(Diflucan ) was compared in the treatment of patients with candiduria. . MATERIALS AND METHODS: A prospective and comparative study of candiduriawas done on 28 patients(Amphotericin B: 13, Fluconazole: 15). Continuous bladder irrigation with 50mg amphotericin B/iota sterile water infused during 24 hours for 2 days was compared to oral administration of 50-100mg/day fluconazole for a range of 7-14 days. Urine culture were obtained 3days, 7 days after continuous bladder irrigation with amphotericin B and 7 days, 14 days after oral administration of fluconazole. RESULTS: The organism was eradicated in 10 patients(76.9%) who received continuous irrigation of amphotericin B and 11 patients(73.3%) who received oral fluconazole therapy. So, There was no statistically significant difference between continuous bladder irrigation with Amphotericin B group and oral medication of fluconazole group(p>0.05). CONCLUSIONS: There was no difference in the cure rate of candiduria between continuous bladder irrigation with Amphotericin B group and oral medication of fluconazole group. So, patient's condition(Foley catheterization, possibility of ambulation and oral feeding) and convinience will be the important deciding factors to select adequate treatment method of candiduria.