Candiduria: Prevalence, Identification of Isolated Candida Species and Trends in Antifungal Susceptibility in Hospitalized Patients
Novelty in Biomedicine,
Vol. 8 No. 2 (2020),
AbstractBackground: Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Some of the predisposing factors of candiduria are extensive use of broad-spectrum anti-fungal agents, diabetes mellitus, indwelling urinary catheter, corticosteroids and, immunosuppressive drugs. There are some antifungal agents available for the treatment of candiduria. In recent years, resistance to antifungal agents has been increased. The aim of this study was to evaluate different Candida species (sp.) that cause candiduria and their susceptibility pattern to antifungal agents in patients admitted to educational hospitals.
Materials and Methods: Urine samples (n=200) were obtained; they were spread onto Sabouraud Dextrose Agar plates. Plates were incubated at 37°C. Only specimens were considered as candiduria, which have a colony count of ≥104 CFU/mL colonies. Urine sediment was cultured in the CHROM agar Candida medium and incubated at 35°C for 48h. The cultures were evaluated based on color. PCR-RFLP was performed for a definite identification of Candida sp. In vitro antifungal susceptibility test of the Candida isolates against amphotericin B, fluconazole and itraconazole was performed using the microdilution method, according to the standard CLSI guidelines, document M27-S3.
Results: Molecular findings confirmed the result of the morphological method. Candiduria rate was 11.5% among our patients. According to CHROM agar Candida and PCR-RFLP, the most common species isolated was C. albicans (74%), followed by C. glabrata (26%). In vitro susceptibility tests of urinary Candida isolates to antifungals have been evaluated. All species were sensitive to amphotericin B. None of C. glabrata isolates were sensitive to fluconazole and itraconazole.
Conclusion: This study demonstrates the importance of Candida sp. in urine samples from hospitalized patients. It was concluded that Candida sp. obtained from candiduria in patients had excellent activity against Amphotericin B. Whereas, resistance against Itraconazole (21.7%) and especially Fluconazole (26%) was significant.
- Urinary tract infection
- Candida sp
- Antifungal susceptibility
How to Cite
Paul N, Mathai E, Abraham OC, Michael JS, Mathai D. Factors associated with candiduria and related mortality. J Infect. 2007;55:450-5.
Fazeli A, Kordbacheh P, Nazari A, Ghazvini RD, Mirhendi H, Safara M, et al. Candiduria in Hospitalized Patients and Identification of Isolated Candida Species by Morphological and Molecular Methods in Ilam, Iran. Iranian journal of public health. 2019;48(1):156.
Krcmery S, Dubrava M, Krcmery Jr V. Fungal urinary tract infections in patients at risk. International journal of antimicrobial agents. 1999;11(3-4):289-91.
Weinstein RA, Lundstrom T, Sobel J. Nosocomial candiduria: a review. Clinical infectious diseases. 2001;32(11):1602-7.
Gharaghani M, Taghipour S, Halvaeezadeh M, Mahmoudabadi AZ. Candiduria; a review article with specific data from Iran. Turkish journal of urology. 2018;44(6):445.
Kobayashi CCBA, Fernandes OF, Miranda KC, de Sousa ED, Silva M. Candiduria in hospital patients: a study prospective. Mycopathologia. 2004;158:49-52.
Wayne P. Reference method for broth dilution antifungal susceptibility testing of yeasts, approved standard. CLSI document. 2002;M27-A2.
Lotfali, E. et al. Regulation of ERG3, ERG6, and ERG11 Genes in Antifungal-Resistant isolates of Candida parapsilosis. Iranian Biomedical Journal. 2017;21:275.
Lotfali, E. et al. Antifungal susceptibility analysis of clinical isolates of Candida parapsilosis in Iran. Iranian Journal of Public Health. 2016;45:322.
Mirhendi H, Makimura K, Khoramizadeh M, Yamaguchi H. A one-enzyme PCR-RFLP assay for identification of six medically important Candida species. Nippon Ishinkin Gakkai Zasshi. 2006;47(3):225-9.
Latha R, Sasikala R, Muruganandam N, Babu RV. Study on the shifting patterns of Non Candida albicans Candida in lower respiratory tract infections and evaluation of the CHROMagar in identification of the Candida species. Journal of Microbiology and Biotechnology Research. 2011;1(3):113-9.
Mahmoudabadi AZ, Rezaei-Matehkolaei A, Ghanavati F. The susceptibility patterns of Candida species isolated from urine samples to posaconazole and caspofungin. Jundishapur journal of microbiology. 2015;8(3).
ZAREI MA, Zarrin M, BEHESHTI FM. Antifungal Susceptibility of Candida species isolated from candiduria. 2013.
Seifi Z, Azish M, Salehi Z, Mahmoudabadi AZ, Shamsizadeh A. Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz. Journal of nephropathology. 2013;2(2):122.
Esmailzadeh A, Zarrinfar H, Fata A, Sen T. High prevalence of candiduria due to non‐albicans Candida species among diabetic patients: A matter of concern? Journal of clinical laboratory analysis. 2018;32(4):e22343.
Jozepanahi M, Mobaien A, Karami A, Ahadi S. Frequency of candiduria in patients hospitalized in intensive care units. Journal of Kerman University of Medical Sciences. 2015.
Bahmaei M, Dehghan P, Mohammadi R, Chabavizadeh J, Mahaki B. Identification of Candida Species Isolated from Candiduria Patients Using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism in Isfahan, Iran. 2016.
Yazdani M, Foroughifar E, Mohammadi R. Identification of Candida species isolated from renal transplant recipients with candiduria. International journal of organ transplantation medicine. 2016;7(4):206.
Azad M, Chabavizadeh J, Dehghan P, Mohammadi R. The frequency of candiduria in hospitalized patients at nephrology department, Labbafinejad hospital, Tehran, Iran. 2017;35.
Zarei MA, Kheradmand A, Enayat EN. Frequency of candiduria in inpatients and outpatients in department of urology, Golestan hospital, Ahvaz, Iran. 2009.
Zarei-Mahmoudabadi A, Zarrin M, Ghanatir F, Vazirianzadeh B. Candiduria in hospitalized patients in teaching hospitals of Ahvaz. Iranian journal of microbiology. 2012;4(4):198.
Gholamipour P, Mahmoudi S, Pourakbari B, ASHTIANI MTH, Sabouni F, Teymuri M, et al. Candiduria in children: a first report from an Iranian referral pediatric hospital. Journal of preventive medicine and hygiene. 2014;55(2):54.
Johnson SA, Guzman MG, Aguilera CT. Candida (Monilia) albicans: effect of amino acids, glucose, pH, chlortetracycline (aureomycin), dibasic sodium and calcium phosphates, and anaerobic and aerobic conditions on its growth. AMA archives of dermatology and syphilology. 1954;70(1):49-60.
Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer A, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. Clinical Infectious Diseases. 2000;30(1):14-8.
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. Critical care medicine. 1999;27(5):887-92.
Álvarez-Lerma F, Nolla-Salas J, León C, Palomar M, Jordá R, Carrasco N, et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive care medicine. 2003;29(7):1069-76.
Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clinical microbiology reviews. 2010;23(2):253-73.
Bukhary ZA. Candiduria: a review of clinical significance and management. Saudi Journal of Kidney Diseases and Transplantation. 2008;19(3):350.
Kauffman CA. Diagnosis and management of fungal urinary tract infection. Infectious Disease Clinics. 2014;28(1):61-74.
Kooshki P, Rezaei-Matehkolaei A, Mahmoudabadi AZ. The patterns of colonization and antifungal susceptibility of Candida, isolated from preterm neonates in Khorramabad, South West of Iran. Journal de mycologie medicale. 2018;28(2):340-4.
Chakrabarti A, Reddy T, Singhi S. Does candiduria predict candidaemia? The Indian journal of medical research. 1997;106:513-6.
Ozhak-Baysan B, Ogunc D, Colak D, Ongut G, Donmez L, Vural T, et al. Distribution and antifungal susceptibility of Candida species causing nosocomial candiduria. Sabouraudia. 2012;50(5):529-32.
Malani AN, Kauffman CA. Candida urinary tract infections: treatment options. Expert Review of Anti-infective Therapy. 2007;5(2):277-84.
Sullivan KA, Caylor MM, Lin F-C, Campbell-Bright S. Comparison of amphotericin B bladder irrigations versus fluconazole for the treatment of candiduria in intensive care unit patients. Journal of pharmacy practice. 2017;30(3):347-52.
Fisher JF. Candida urinary tract infections—epidemiology, pathogenesis, diagnosis, and treatment: executive summary. Clinical infectious diseases. 2011;52(suppl_6):S429-S32.
Fidel PL, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison toC. albicans. Clinical microbiology reviews. 1999;12(1):80-96.
Vazquez JA, Dembry LM, Sanchez V, Vazquez MA, Sobel JD, Dmuchowski C, et al. Nosocomial Candida glabrata colonization: an epidemiologic study. Journal of Clinical Microbiology. 1998;36(2):421-6.
- Abstract Viewed: 364 times
- PDF Downloaded: 148 times