Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): Deviations from international guidelines and fluconazole therapeutic failure

Amir Arastehfar, Sara Khanjari, Zahra Zareshahrabadi, Wenjie Fang, Weihua Pan, Elham Asadpour, Farnaz Daneshnia, Macit Ilkit, Teun Boekhout, David S. Perlin, Farid Zand, Kamiar Zomorodian

Research output: Contribution to journalArticlepeer-review

Abstract

Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistancewas rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.

Original languageEnglish (US)
Pages (from-to)600-607
Number of pages8
JournalMedical mycology
Volume59
Issue number6
DOIs
StatePublished - Jun 1 2021

All Science Journal Classification (ASJC) codes

  • Infectious Diseases

Keywords

  • Candida
  • antifungal drug resistance
  • candiduria
  • fluconazole
  • intensive care unit

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