Comparison of Monomicrobial versus Polymicrobial Candiduria: Time to Awareness of Candiduria

Hyunji Kim; Mi-Kyung Lee; Tae-Hyoung Kim

doi:10.14777/uti.2019.14.1.20

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Kim, Lee, and Kim: Comparison of Monomicrobial versus Polymicrobial Candiduria: Time to Awareness of Candiduria

Original Article

Urogenit Tract Infect 2019;14(1):20-25.

Published online: 20 April 2019

DOI: https://doi.org/10.14777/uti.2019.14.1.20

Comparison of Monomicrobial versus Polymicrobial Candiduria: Time to Awareness of Candiduria

Hyunji Kim, Mi-Kyung Lee, Tae-Hyoung Kim^1,

Department of Laboratory Medicine, Seoul, Korea

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

Correspondence to: Tae-Hyoung Kim https://orcid.org/0000-0002-0257-3449 Department of Urology, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea Tel: +82-2-6299-1818, Fax: +82-2-6298-8630 E-mail: kthlmk@nate.com

Received 1 April 2019 Revised 25 April 2019 Accepted 26 April 2019

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

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.

Materials and Methods

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.

Results

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).

Conclusions

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.

Keywords: Candida, Urinary tract infections, Candidiasis, Polymicrobial infection

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Table 1.

Clinical characteristics and comparison of the patients with monomicrobial candiduria and polymicrobial candiduria

Variable	Monomicrobial candiduria (n=128)	Polymicrobial candiduria (n=57)	p-value^a)
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.

^a) Mann–Whitney U test.

Table 2.

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.

Table 3.

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)

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