Distribution of yeasts in fungal urinary tract infections from a tertiary care hospital

Year 2023, Volume: 4 Issue: 4, 296 - 301, 30.08.2023

Rabiye Altınbaş , Yaşar Bildirici

https://doi.org/10.47582/jompac.1325399

Abstract

Aims: Urinary tract infections caused by fungi in critically ill patients steadily increasing in recent years. Fungiuria is a marker of contamination, colonization, or infection in the lower or upper urinary tract. As urinary catheters especially long-term usage was the most important risk factor for fungiuria. The identification of yeast isolates at the species level is crucial for the appropriate management of infection. We conducted this study to describe the epidemiological features of fungiuria in patients.
Methods: The yeast species were identified by using conventional methods and automated systems. Demographic data were recorded from the electronic medical records.
Results: Candida albicans, were predominant compared to non-albicans Candida species and yeast-like fungi. Among non-albicans Candida, the most common species were Candida tropicalis followed by Candida glabrata complex. Fungiuria was more common in females than in males. Underlying conditions were present in patients the most common risk factors were antibiotic therapy before the detection of yeasts and using a urinary catheter.
Conclusion: Epidemiological data and antimicrobial therapy play an important role in the treatment of urinary tract infections. For this reason, the identification of fungi at the species level is critical to assist the decision on antifungal therapy in complex cases. In all patients with fungal growth in urine culture, the underlying risk factors should be evaluated first. Depending on the correction of risk factors, fungiuria may resolve spontaneously. This is seen as the best approach both to reduce treatment costs and to prevent resistance to antifungals.

Keywords

Fungiuria, Candiduria, urinary tract infection, urinary catheter

Eskişehir'de üçüncü basamak bir hastanedeki fungal üriner sistem enfeksiyonlarından izole edilen mayaların dağılımı

Abstract

Amaç: Mantarların neden olduğu idrar yolu enfeksiyonları kritik hastalarda son yıllarda giderek artmaktadır. Fungiüri, alt veya üst üriner sistemde kontaminasyon, kolonizasyon veya enfeksiyonun bir belirtecidir. Üriner kateterin uzun süreli kullanım, fungiüri için en önemli risk faktörüdür. Maya izolatlarının tür düzeyinde tanımlanması, enfeksiyonun uygun yönetimi için çok önemlidir. Bu çalışma fungiüri gelişen hastaların epidemiyolojik özelliklerini tanımlamak amacı ile yapıldı.
Yöntem: Maya türleri, konvansiyonel yöntemler ve otomatize sistemler kullanılarak tanımlanmıştır. Demografik veriler için elektronik tıbbi kayıtlar kullanılmıştır.
Bulgular: Candida albicans, non-albicans Candida türlerine ve maya benzeri mantarlara göre baskın olarak bulundu. Albicans dışı Candida türleri arasında en yaygın tür C. tropicalis ve ardından C. glabrata olarak bulundu. Fungiüri kadınlarda erkeklerden daha yaygın olarak saptandı. Hastalarda altta yatan risk faktörleri mevcuttu, en yaygın risk faktörleri; maya saptanmadan önce antibiyotik tedavisi ve idrar sondası kullanılmasıydı.
Sonuç: Epidemiyolojik veriler ve ampirik antimikrobiyal tedavi üriner sistem enfeksiyonlarının tedavisinde önemli rol oynamaktadır. Bu nedenle, mantarların tür düzeyinde tanımlanması, karmaşık vakalarda antifungal tedavi kararına yardımcı olmak için kritik öneme sahiptir. İdrar kültüründe mantar üremesi olan tüm hastalarda öncelikle altta yatan risk faktörleri değerlendirilmelidir. Risk faktörlerinin düzeltilmesine bağlı olarak fungiüri kendiliğinden düzelebilir. Bu hem tedavi maliyetlerini azaltmak hem de antifungallere direnci önlemek için en iyi yaklaşım olarak görülmektedir.

Keywords

Fungiuri, Candiduri, üriner sistem enfeksiyonu, üriner kateter

References

• Dias V. Candida species in the urinary tract: Is it a fungal infection or not? Future Microbiol. 2020;15(2):81-83. doi:10.2217/fmb-2019-0262
• Yadav RK, Singh G, Kiran KS, et al. A study on candiduria in neonates and infants from a tertiary care center, North India. Indian J Med Microbiol. 2023;42(June 2022):25-29. doi:10.1016/j.ijmmb.2022.12.014
• Gharaghani M, Taghipour S, Halvaeezadeh M, Mahmoudabadi AZ. Candiduria; a review article with specific data from Iran. Turkish J Urol. 2018;44(6):445-452. doi:10.5152/tud.2018.54069
• Malhotra S. Occurrence of Candiduria in Paediatric Patients and its Antifungal Susceptibility in a Tertiary Care Centre. J Infect Dis Med. 2017;2(1):2-5.
• He Z, Su C, Bi Y, Cheng Y, Lei D, Wang F. Evaluation of a novel laboratory candiduria screening protocol in the intensive care unit. Infect Drug Resist. 2021;14:489-496. doi:10.2147/IDR.S289885
• Odabasi Z, Mert A. Candida urinary tract infections in adults. World J Urol. 2020;38(11):2699-2707. doi:10.1007/s00345-019-02991-5
• Behzadi P, Behzadi E, Ranjbar R. Urinary tract infections and Candida albicans. Cent Eur J Urol. 2015;68(1):96-101. doi:10.5173/ceju.2015.01.474
• He Z, Huo X, Lei D, Zhao H, Jia K, Wang F. Management of candiduria in hospitalized patients: a single-center study on the implementation of IDSA guidelines and factors affecting clinical decisions. Eur J Clin Microbiol Infect Dis. 2021;40(1):59-65. doi:10.1007/s10096-020-03999-1
• Tan X, Baugh K, Bulman ZP, Wenzler E. Review of the current management of urinary tract infections due to fluconazole-resistant and non-albicans Candida species. Curr Fungal Infect Rep. 2020;14(3):268-278. doi:10.1007/s12281-020-00388-1
• Kobayashi CCBA, De Fátima Lisboa Fernandes O, Miranda KC, De Sousa ED, Do Rosário Rodrigues Silva M. Candiduria in hospital patients: A study prospective. Mycopathologia. 2004;158(1):49-52. doi:10.1023/B:MYCO.0000038436.51918.d9
• Chaari A, Munir A, Sharaf A, Khairy A, Kauts V, Erdem H. Predictive factors and prognostic value of candiduria in critically-ill patients with solid and hematological malignancies. J Med Mycol. 2023;33(1):101353. doi:10.1016/j.mycmed.2022.101353
• Alfouzan WA, Dhar R. Candiduria: Evidence-based approach to management, are we there yet? J Mycol Med. 2017;27(3):293-302. doi:10.1016/j.mycmed.2017.04.005
• Hollenbach E. To treat or not to treat - Critically ill patients with candiduria. Mycoses. 2008;51(SUPPL.2):12-24. doi:10.1111/j.1439-0507.2008.01570.x
• Shirvani F, Fattahi M. Molecular identification of Candida species isolated from candiduria and its risk factors in neonates and children. Curr Med Mycol. 2021;17(3):9-12. doi:10.18502/CMM.7.3.7799
• Kauffman CA. Diagnosis and management of fungal urinary tract infection. Infect Dis Clin North Am. 2014;28(1):61-74. doi:10.1016/j.idc.2013.09.004
• Fisher JF, Kavanagh K, Sobel JD, Kauffman CA, Newman CA. Candida urinary tract infection: Pathogenesis. Clin Infect Dis. 2011;52(SUPPL. 6):437-451. doi:10.1093/cid/cir110
• He Z, Liu Y, Wang T, Cheng Y, Chen J, Wang F. Candiduria in hospitalized patients: An investigation with the Sysmex UF-1000i urine analyzer. PeerJ. 2019;2019(5). doi:10.7717/peerj.6935
• Poloni JAT, Rotta LN. Urine sediment findings and the immune response to pathologies in fungal urinary tract infections caused by Candida spp. J Fungi. 2020;6(4):1-12. doi:10.3390/jof6040245
• Francisco EC, de Almeida Junior JN, de Queiroz Telles F, et al. Species distribution and antifungal susceptibility of 358 Trichosporon clinical isolates collected in 24 medical centres. Clin Microbiol Infect. 2019;25(7):909.e1-909.e5. doi:10.1016/j.cmi.2019.03.026
• Gajdács M, Dóczi I, Ábrók M, Lázár A, Burián K. Epidemiology of candiduria and Candida urinary tract infections in inpatients and outpatients: Results from a 10-year retrospective survey. Cent Eur J Urol. 2019;72(2):209-214. doi:10.5173/ceju.2019.1909
• Gharaghani M, Rezaei-Matehkolaei A, Hardani AK, Mahmoudabadi AZ. Genetic analysis of Candida glabrata from candiduric patients using microsatellite length polymorphism, antifungal susceptibility, and enzymatic profiles. Jundishapur J Microbiol. 2021;14(1):1-8. doi:10.5812/jjm.113716
• Kauffman CA, Fisher JF, Sobel JD, Newman CA. Candida urinary tract infections - Diagnosis. Clin Infect Dis. 2011;52(SUPPL. 6). doi:10.1093/cid/cir111
• Fulton MA, Wallace B, Akins R, Teresa L. A Win for Patient Safety: Collaboration to Curb Catheter-Associated Urinary Tract Infections (CAUTIs) due to Candida species. Am J Infect Control. 2015;43(6):S47-S48. doi:10.1016/j.ajic.2015.04.120
• Rkieh L, El Nekidy WS, Alsoud LO, et al. Outcomes of caspofungin use in the treatment of Candida-related urinary tract infections, a case series. IDCases. 2022;28(May):e01510. doi:10.1016/j.idcr.2022.e01510
• Pramodhini S, Srirangaraj S, Easow JM. Candiduria—study of virulence factors and its antifungal susceptibility pattern in tertiary care hospital. J Lab Physicians. 2021;13(03):231-237. doi:10.1055/s-0041-1730880
• Demir C, Metin S. Microorganisms grown in urine cultures and antimicrobial resistance patterns: A randomised retrospective analysis from a tertiary hospital. J Infect Dev Ctries. 2023;17(3):337-344. doi:10.3855/jidc.17483
• García-Agudo L, Rodríguez-Iglesias M, Carranza-González R. Nosocomial Candiduria in the Elderly: Microbiological Diagnosis. Mycopathologia. 2018;183(3):591-596. doi:10.1007/s11046-017-0232-7
• Toka Özer T, Durmaz S, Yula E. Antifungal susceptibilities of Candida species isolated from urine culture. J Infect Chemother. 2016;22(9):629-632. doi:10.1016/j.jiac.2016.06.012
• Paul N, Mathai E, Abraham OC, Michael JS, Mathai D. Factors associated with candiduria and related mortality. J Infect. 2007;55(5):450-455. doi:10.1016/j.jinf.2007.06.010
• Singla N, Gulati N, Kaistha N, Chander J. Candida colonization in urine samples of ICU patients: determination of etiology, antifungal susceptibility testing and evaluation of associated risk factors. Mycopathologia. 2012;174(2):149-155. doi:10.1007/s11046-011-9514-7
• Esmailzadeh A, Zarrinfar H, Fata AM, Sen T. High prevalence of candiduria due to non-albicans Candida species among diabetic patients: A matter of concern? J Clin Lab Anal. 2018;32(4):1-5. doi:10.1002/jcla.22343
• McMorris TE, Smith WJ, Kupiec K, et al. Micafungin therapy for symptomatic candiduria in hospitalized patients: A review of 14 cases. Infect Dis Clin Pract. 2017;25(2):88-93. doi:10.1097/IPC.0000000000000461
• Bukhary ZA. Candiduria: a review of clinical significance and management. Saudi J Kidney Dis Transpl. 2008;19(3):350-360.
• Hosseini SS, Ghaemi E, Noroozi A, Niknejad F. Zinc oxide nanoparticles inhibition of initial adhesion and ALS1 and ALS3 gene expression in Candida albicans strains from urinary tract infections. Mycopathologia. 2019;0123456789. doi:10.1007/s11046-019-00327-w
• De Sousa IA, Braoios A, Santos TG, De Lima JA, Da Costa RM. Candiduria in adults and children: Prevalence and antifungal susceptibility in outpatient of Jataí-GO. J Bras Patol e Med Lab. 2014;50(4):259-264. doi:10.5935/1676-2444.20140024
• ÖDEMİŞ İ, İMRE A. Katater ilişkili üriner sistem enfeksiyonlarında mortalite ile ilişkili faktörlerin değerlendirilmesi, 5 yıllık retrosepektif çalışma. Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Derg. 2022:0-3. doi:10.17517/ksutfd.1146548
• Korkmaz D, Demirtürk N, Keşli R, Konya P. Hospitalize kandidürili hastalarda risk faktörlerinin araştırılması. Acta Medica Alanya. 2019;3(1):72-77. doi:10.30565/medalanya.519111