Candiduria, which is the presence of Candida species in urine, is becoming increasingly common in hospital settings. These normal commensals in humans are often associated with the presence of other microorganisms. In this study, patients presenting with monomicrobial and polymicrobial candiduria were compared.
A retrospective study was performed on the demographic, clinical, and laboratory data of 185 patients presenting with candiduria between July 2014 and June 2015 at Chung-Ang University Hospital. The threshold for a positive Candida species urine culture was set to 103 CFU/ml. Data on the following were evaluated: distribution of Candida species; patient age and sex; length of hospital stay; presence of diabetes mellitus (DM), chronic kidney disease (CKD), a urinary catheter, and fever; antibiotic administration; urinalysis; complete blood cells; and C-reactive protein.
Monomicrobial candiduria was more common (128/185, 69.2%) than polymicrobial candiduria (57/185, 30.8%). The most prevalent species was Candida albicans (monomicrobial vs. polymicrobial candiduria, 61.7% vs. 54.4%), followed in order by Candida tropicalis (18.8% vs. 24.6%), and Candida glabrata (14.8% vs. 12.3%), with no significant difference between the two groups. Significant differences in the length of stay, underlying DM or CKD, accompanying symptoms, and urine white blood cells (WBC) and bacterial counts were observed between the two groups (p＜0.05).
The length of stay, underlying DM or CKD, accompanying symptoms, and urine WBC and bacterial counts were more associated with polymicrobial candiduria. The early detection and treatment of candiduria will become increasingly important as the Korean population ages.
Clinical characteristics and comparison of the patients with monomicrobial candiduria and polymicrobial candiduria
| Variable | Monomicrobial candiduria (n=128) | Polymicrobial candiduria (n=57) | p-value |
|---|---|---|---|
| Female (%) | 64.1 | 63.2 | – |
| Age (y) | 71.1±19.2 (2–99) | 73.0±14.2 (35–95) | 0.718 |
| Length of hospital stay (d) | 62.1±57.8 (3–342) | 95.1±82.1 (4–354) | 0.018 |
| Diabetes mellitus (%) | 36.7 | 54.4 | 0.025 |
| Chronic kidney disease (%) | 7.8 | 21.1 | 0.004 |
| Presence of urinary catheter (%) | 80.5 | 75.4 | 0.425 |
| Administration of antibiotics (<3 mo) (%) | 90.6 | 94.7 | 0.345 |
| Fever (%) | 71.1 | 80.7 | 0.170 |
| General weakness (%) | 8.6 | 24.6 | 0.003 |
| Voiding difficulty (%) | 0.0 | 8.8 | 0.001 |
| Urinalysis | |||
| WBCs | 1.3±1.2 (0.0–3.0) | 1.7±1.2 (0.0–3.0) | 0.013 |
| Bacteria | 1.8±0.9 (0.0–4.0) | 2.5±1.0 (0.0–4.0) | ＜0.001 |
| Yeast | 2.0±1.4 (0.0–4.0) | 2.2±1.5 (0.0–4.0) | 0.381 |
| Candida | 1.3±1.4 (0.0–4.0) | 1.6±1.3 (0.0–4.0) | 0.168 |
| pH | 5.7±1.1 (5.0–8.5) | 5.8±1.1 (5.0–8.0) | 0.441 |
| Complete blood count | |||
| WBCs (×103/l) | 11.2±6.1 (0.2–47.7) | 10.7±5.8 (1.3–34.7) | 0.398 |
| Neutrophil-to-lymphocyte ratio (%) | 10.4±13.8 (0.4–97.0) | 8.0±9.0 (0.1–47.7) | 0.153 |
| hs-CRP | 80.4±75.6 (0.2–379.8) | 62.1±60.1 (0.2–230.3) | 0.171 |
Values are presented as % only or mean±standard deviation (range).
WBCs: white blood cells, hs-CRP: high-sensitivity C-reactive protein.
Mann–Whitney U test.
Type and number of Candida species identified in urine cultures
| Microorganism | Monomicrobial candiduria (n=128) | Polymicrobial candiduria (n=57) |
|---|---|---|
| C. albicans | 79 (61.7) | 31 (54.4) |
| C. tropicalis | 24 (18.8) | 14 (24.6) |
| C. glabrata | 19 (14.8) | 7 (12.3) |
| C. parapsilosis | 2 (1.6) | 1 (1.8) |
| C. lusitaniae | 2 (1.6) | 0 (0.0) |
| C. famata | 1 (0.8) | 1 (1.8) |
| C. utilis | 1 (0.8) | 2 (3.5) |
| C. krusei | 0 (0.0) | 1 (1.8) |
Values are presented as number of identified (%).
There were no differences in the distribution of Candida species between the two groups.
Microorganisms associated with polymicrobial candiduria (n=57)
| Microorganism | No. of identified (%) |
|---|---|
| Gram-positive bacteria | |
| Enterococcus faecium | 23 (40.4) |
| Enterococcus faecalis | 8 (14.0) |
| Staphylococcus aureus | 3 (5.3) |
| Enterococcus gallinarum | 1 (1.8) |
| Gram-negative bacteria | |
| Acinetobacter baumannii | 6 (10.5) |
| Escherichia coli | 4 (7.0) |
| Pseudomonas aeruginosa | 3 (5.3) |
| Acinetobacter lwoffii | 2 (3.5) |
| Klebsiella pneumoniae | 1 (1.8) |
| Fungi | |
| Candida albicans– Candida glabrata | 3 (5.3) |
| C. albicans– Candida tropicalis | 1 (1.8) |
| C. albicans– Candida kefyr | 1 (1.8) |
| C. tropicalis– C. glabrata | 1 (1.8) |