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Purpose: This study evaluated candiduria therapy in adult intensive care unit (ICU) and non-ICU patients at an academic medical center in order to define the epidemiology, management, and outcomes associated with candiduria in these patient populations.
Methods: Medical records of patients with candiduria from July 2010 through June 2011 were reviewed in this retrospective, single center study. Patients were included if they were between the ages of 18 and 75 years, and were admitted for a minimum of 5 days. Laboratory data, urinary symptoms, risk factors for urinary and invasive candidiasis, treatment decisions, and patient outcomes were collected and evaluated.
Results: One-hundred and thirty-two patients met inclusion criteria, 67 from intensive care units (ICU) and 65 from non-intensive care units (non-ICU). The mean age was just over 50 years, and the majority of patients were female in both groups. The mean APACHEII score for the ICU patients was 24.9 + 8.1. Patients in the ICU were more likely to have risk factors for invasive candidiasis and candiduria compared to non-ICU patients. Candida albicans was the most frequently identified isolate, followed closely by Candida glabrata. Fluconazole was the most commonly used antifungal agent, followed by micafungin and voriconazole. Hospital length of stay did not vary significantly between the groups (P=0.0628). All cause mortality was significantly higher in the ICU patients compared to the non-ICU patients (22.4% vs 3.1%, p=0.0012).
Conclusion: Differences exist between ICU and non-ICU patients that develop candiduria with respect to risk factors, management, and outcomes. Antifungals were often used inappropriately (i.e. asymptomatic patients) in both patient cohorts. Especially concerning was the frequent use of micafungin and voriconazole since neither is recommended in the consensus treatment guidelines and both have very poor urinary penetration.