Profiles of Yeast Isolated from Urinary Tracts with and without Catheter during 2011-2013

Jae Hyung Ryu; Tae-Hyoung Kim; Oh Joo Kweon; Mi-Kyung Lee

doi:10.14777/kjutii.2014.9.2.93

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Ryu, Kim, Kweon, and Lee: Profiles of Yeast Isolated from Urinary Tracts with and without Catheter during 2011-2013

Original Article

Korean J Urogenit Tract Infect Inflamm 2014;9(2):93-98.

Published online: 17 October 2014

DOI: https://doi.org/10.14777/kjutii.2014.9.2.93

Profiles of Yeast Isolated from Urinary Tracts with and without Catheter during 2011-2013

Jae Hyung Ryu, Tae-Hyoung Kim, Oh Joo Kweon¹, Mi-Kyung Lee^1,

Department of Urology, Chung-Ang University College of Medicine, Seoul, Korea

¹Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to: Mi-Kyung Lee Department of Laboratory Medicine, Chung-Ang University Hospital, 102, Heukseok-ro, Dongjak-gu, Seoul 156-755, Korea Tel: +82-2-6299-2719, Fax: +82-2-6298-8630 E-mail: cpworld@cau.ac.kr

Received 8 October 201417 October 2014 Accepted 20 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Indwelling urinary catheter is considered the most important risk factor for healthcare-associated urinary tract infection (UTI). The aim of the current study was to compare the prevalence of species distribution and susceptibilities of antifungals against clinical isolates of yeasts from funguria with and without urinary catheter.

Materials and Methods

We analyzed 45,839 urine specimens collected from patients between 2011 and 2013. Species identification and antifungal susceptibility test to amphotericin B, fluconazole, voriconazole, and flucytosine were performed using the VITEK 2 system (Biomérieux Inc.).

Results

A total of 1,048 (2.29%) urine specimens were yeast culture positive. The most frequent species was Candida albicans (49.0%), followed by C. tropicalis (18.6%), C. glabrata (12.2%), and Trichosporon asahii (7.2%). C. tropicalis was isolated more frequently in catheterized urine than in voided urine (p＜0.05). For C. albicans and C. glabrata, frequencies of non-susceptible to fluconazole or voriconazole were higher in catheterized urine than in voided urine.

Conclusions

The results of this study suggest the possibility that urinary catheter may influence species distribution of yeast and antifungal susceptibilities. Further investigation is warranted to improve infection control strategies for healthcare-associated UTI.

Keywords: Urinary tract infections, Urinary catheters, Yeasts, Microbial sensitivity tests

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Table 1.

Species distribution of yeast isolates of urinary tract infections according to the specimen sampling technique

Organisms (isolates no.)	Isolates, n (%)		p-value
Organisms (isolates no.)	Voided urine	Catheterized urine	p-value
Candida albicans (514)	73 (55.3)	441 (48.2)	0.178
C. tropicalis (195)	15 (11.4)	180 (19.7)	0.018^∗
C. glabrata (128)	24 (18.2)	104 (11.4)	0.031^∗
Trichosporon asahii (75)	9 (6.8)	66 (7.2)	0.832
C. famata (51)	4 (3.0)	47 (5.1)	0.278
C. utilis (43)	6 (4.5)	37 (4.0)	0.815
C. parapsilosis (22)	0 (0.0)	22 (2.4)	0.069
Cryptococcus laurentii (8)	0 (0.0)	8 (0.9)	0.277
C. lusitaniae (5)	1 (0.8)	4 (0.4)	0.628
C. krusei (3)	1 (0.8)	2 (0.2)	0.286
C. guilliermondii (1)	0 (0.0)	1 (0.1)
C. kefyr (1)	0 (0.0)	1 (0.1)
Unidentified (2)	1 (0.8)	1 (0.1)
Total (1,048)	134 (100)	914 (100)

^∗ p＜0.05.

Table 2.

Antifungal susceptibilities of 134 yeast isolates from voided urine specimens

Species (isolates no.)	Antifungal agent	MIC (μg/ml)			MICs by category (%)
Species (isolates no.)	Antifungal agent	Range	MIC₅₀	MIC₉₀	S	SDD/I^a	R
Candida albicans (73)	Amphotericin B	≤0.25-1	0.5	1	100.0	0.0	0.0
	Fluconazole	≤1-2	≤1	≤1	100.0	0.0	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1-≥64	≤1	≤1	94.6	2.7	2.7
C. tropicalis (15)	Amphotericin B	≤0.25-0.5	0.25	0.25	100.0	0.0	0.0
	Fluconazole	≤1	≤1	≤1	100.0	0.0	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
C. glabrata (24)	Amphotericin B	≤0.25-1	0.5	0.5	100.0	0.0	0.0
	Fluconazole	2-≥16	8	16	100.0	0.0	0.0
	Voriconazole	≤0.12-1	0.12	0.25	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
Trichosporon asahii (9)	Amphotericin B	≤0.25-2	0.5	2	88.9	0.0	11.1
	Fluconazole	2-≥64	2	≥64	88.9	0.0	11.1
	Voriconazole	≤0.12-1	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1-8	≤1	4	88.9	11.1	0.0
Others (13)	Amphotericin B	≤0.25-0.5	0.25	0.5	100.0	0.0	0.0
	Fluconazole	≤1-16	≤1	≤1	92.3	7.7	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1-16	≤1	≤1	92.3	7.7	0.0
Total (134)	Amphotericin B	≤0.25-2	≤0.5	1	99.3	0.0	0.7
	Fluconazole	≤0.25-≥64	≤1	≤1	98.6	0.7	0.7
	Voriconazole	≤0.12-1	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1-≥64	≤1	≤1	95.5	3.0	1.5

MIC: minimum inhibitory concentration, S: susceptible, SDD: susceptible dose dependent, I: intermediate, R: resistant.

^a :For flucytosine, the available data do not permit the MIC results to be clearly categorized as either "susceptible" or "resistant".

Table 3.

Antifungal susceptibilities of 914 yeast isolates from catheterized urine specimens

Species (isolates no.)	Antifungal agent	MIC (μg/ml)			MICs by category (%)
Species (isolates no.)	Antifungal agent	Range	MIC₅₀	MIC₉₀	S	SDD/I^a	R
Candida albicans (441)	Amphotericin B	≤0.25-1	0.5	1	100.0	0.0	0.0
	Fluconazole	≤1-16	≤1	≤1	96.0	3.6	0.4
	Voriconazole	≤0.12-4	≤0.12	≤0.12	99.3	0.2	0.5
	Flucytosine^a	≤1-≥64	≤1	≤1	98.2	0.2	1.6
C. tropicalis (180)	Amphotericin B	≤0.25-1	≤0.2	0.5	100.0	0.0	0.0
	Fluconazole	≤1-4	≤1	≤1	99.4	0.6	0.0
	Voriconazole ^a	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
C. glabrata (104)	Amphotericin B	≤0.25-2	0.5	1	99.0	0.0	1.0
	Fluconazole	≤1-≥16	8	16	100.0	0.0	0.0
	Voriconazole	≤0.12-4	≤0.12	0.25	94.3	3.8	1.9
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
Trichosporon asahii (66)	Amphotericin B	≤0.25-2	0.5	1	95.5	0.0	4.5
	Fluconazole	≤1-≥64	2	4	98.5	0.0	1.5
	Voriconazole	≤0.12-1	≤0.12	≤0.12	98.5	1.5	0.0
	Flucytosine^a	≤0.12-8	2	4	93.9	6.1	0.0
C. famata (47)	Amphotericin B	≤0.25-1	≤0.25	0.5	100.0	0.0	0.0
	Fluconazole	≤1-4	≤1	≤1	100.0	0.0	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
C. utilis (37)	Amphotericin B	≤0.25-0.5	≤0.25	0.5	100.0	0.0	0.0
	Fluconazole	≤1	≤1	≤1	100.0	0.0	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
C. parapsilosis (22)	Amphotericin B	≤0.25-1	≤0.25	1	100.0	0.0	0.0
	Fluconazole	≤1-2	≤1	≤1	100.0	0.0	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1	≤1	≤1	100.0	0.0	0.0
Others (17)	Amphotericin B	≤0.25-2	≤0.25	1	94.1	5.9	0.0
	Fluconazole	≤1-16	≤1	2	94.1	5.9	0.0
	Voriconazole	≤0.12	≤0.12	≤0.12	100.0	0.0	0.0
	Flucytosine^a	≤1-8	≤1	≤1	88.2	11.8	0.0
Total (914)	Amphotericin B	≤0.25-2	≤0.25	0.5	99.6	0.0	0.4
	Fluconazole	≤1-≥64	≤1	2	99.3	0.4	0.3
	Voriconazole	≤0.12-4	≤0.12	≤0.12	98.9	0.7	0.4
	Flucytosine^a	≤1-≥64	≤1	≤1	98.6	0.7	0.7

MIC: minimum inhibitory concentration, S: susceptible, SDD: susceptible dose dependent, I: intermediate, R: resistant.

^a :For flucytosine, the available data do not permit the MIC results to be clearly categorized as either "susceptible" or "resistant".

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