Mycopathologia

, Volume 183, Issue 3, pp 591–596 | Cite as

Nosocomial Candiduria in the Elderly: Microbiological Diagnosis

  • Lidia García-Agudo
  • Manuel Rodríguez-Iglesias
  • Rafael Carranza-González
Short Communication
  • 68 Downloads

Abstract

Candiduria is associated with high morbidity, mortality, and long hospitalization, involving high costs for the healthcare system. The use of increasingly aggressive treatments has prolonged the lives of patients susceptible to candiduria, namely the immunosuppressed, the premature, and the elderly. Our objective was to evaluate the incidence of nosocomial candiduria and the implicated species in hospitalized patients aged over 80 years old from three Spanish centers during 2012 and 2013. Urine samples received from these patients were cultured and analyzed by flow cytometry in search of leukocyturia, hematuria, proteinuria, and microbial nitrate reductase activity. The isolated yeast species were identified microscopically, by germ tube formation in serum, colony morphology after subculture onto CHROMagar Candida (Becton–Dickinson, UK), assimilation of carbon compounds ID32C (bioMérieux, France), matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDITOF) (Bruker Daltonics, Germany) and, in case of inconsistency, by sequencing of the ITS regions of ribosomal DNA (ITS1-5, 8S-ITS2). Susceptibility tests were also performed. The incidence of candiduria in the elderly population was 10.3%. A total of 155 strains of yeasts were isolated. The predominant species was Candida albicans, followed by Candida glabrata and then Candida tropicalis. Several infrequent species were found; among them, the first isolate of candiduria-producing Candida pulcherrima described in the literature. Our finding should raise concerns about the elderly population, which is probably the most important risk group for candiduria in the present moment, and the emergence of unusual yeast species producing candiduria, which are resistant against the commonly used antifungal agents.

Keywords

Candiduria Aged, 80 and over Microbiology MALDITOF Ecology 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Zarei-Mahmoudabadi A, Zarrin M, Ghanatir F, Vazirianzadeh B. Candiduria in hospitalized patients in teaching hospitals of Ahvaz. Iran J Microbiol. 2012;4:198–203.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Kobayashi CC, de Fernandes OF, Miranda KC, de Sousa ED, Silva MR. Candiduria in hospital patients: a study prospective. Mycopathologia. 2004;158:49–52.CrossRefPubMedGoogle Scholar
  3. 3.
    Nucci M. Candiduria in hospitalized patients: a review. Braz J Infect Dis. 2000;4:168–72.PubMedGoogle Scholar
  4. 4.
    Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23:253–73.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Fraisse T, Crouzet J, Lachaud L, Durand A, Charachon S, Lavigne JP, et al. Candiduria in those over 85 years old: a retrospective study of 73 patients. Intern Med. 2011;50:1935–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Kauffman CA, Vazquez JA, Sobel JD, Gallis HA, McKinsey DS, Karchmer AW, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. Clin Infect Dis. 2000;30:14–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Jacobs LG, Skidmore EA, Freeman K, Lipschultz D, Fox N. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. Clin Infect Dis. 1996;22:30–5.CrossRefPubMedGoogle Scholar
  8. 8.
    European Committee on Antimicrobial Susceptibility Testing. Antifungal Agents. Breakpoint tables for interpretation of MICs. Version 8.0. Basel: EUCAST; 2016. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/AFST/Clinical_breakpoints/Antifungal_breakpoints_v_8.0_November_2015.pdf. Access 21st Jan 2017.
  9. 9.
    Institute Clinical Laboratory Standards. M27-S4 reference method for broth dilution antifungal susceptibility testing of yeasts. 4th ed. Wayne: CLSI; 2012.Google Scholar
  10. 10.
    Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections: epidemiology. Clin Infect Dis. 2011;52:S433–6.CrossRefPubMedGoogle Scholar
  11. 11.
    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 Med. 2003;29:1069–76.CrossRefPubMedGoogle Scholar
  12. 12.
    Aubron C, Suzuki S, Glassford NJ, García-Álvarez M, Howden BP, Bellomo R. The epidemiology of bacteriuria and candiduria in critically ill patients. Epidemiol Infect. 2015;143:653–62.CrossRefPubMedGoogle Scholar
  13. 13.
    Delgado J, Calvo N, Gomis A, Pérez-Flores I, Rodríguez A, Ridao N, Valero R, Sánchez-Fructuoso AI. Candiduria in renal transplant recipients: incidence, clinical repercussion, and treatment indication. Transplant Proc. 2010;42:2944–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Alvarez-Lerma F, Palomar M, León C, Olaechea P, Cerdá E, Bermejo B. Indicaciones del tratamiento antifúngico en pacientes ingresados en servicios de medicina intensiva. Enferm Infecc Microbiol Clin. 2004;22:279–85.CrossRefPubMedGoogle Scholar
  15. 15.
    Safdar N, Slattery WR, Knasinski V, Gangnon RE, Li Z, Pirsch JD, et al. Predictors and outcomes of candiduria in renal transplant recipients. Clin Infect Dis. 2005;40:1413–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Tambyah PA, Maki DG. The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med. 2000;160:673–7.PubMedGoogle Scholar
  17. 17.
    Kauffman CA. Candiduria. Clin Infect Dis. 2005;41:S371–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Kang M, Lee S, Jeong SJ, Hong SK, Byun SS, Lee SE, et al. Characteristics and significant predictors of detecting underlying diseases in adults with symptomatic microscopic hematuria: a large case series of a Korean population. Int J Urol. 2015;22:389–93.CrossRefPubMedGoogle Scholar
  19. 19.
    Paul N, Mathai E, Abraham OC, Michael JS, Mathai D. Factors associated with candiduria and related mortality. J Infect. 2007;55:450–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Okulicz JF, Rivard RG, Conger NG, Nguyen MX, Hospenthal DR. Primary isolation of Candida species from urine specimens using chromogenic medium. Mycoses. 2008;51:141–6.CrossRefPubMedGoogle Scholar
  21. 21.
    de Oliveira RD, Maffei CM, Martinez R. Infecção urinária hospitalar por leveduras do gênero Candida. Rev Assoc Med Bras. 2001;47:231–5.CrossRefPubMedGoogle Scholar
  22. 22.
    Colodner R, Nuri Y, Chazan B, Raz R. Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics. Eur J Clin Microbiol Infect Dis. 2008;27:301–5.CrossRefPubMedGoogle Scholar
  23. 23.
    Miceli MH, Diaz JA, Lee SA. Emerging opportunistic yeast infections. Lancet Infect Dis. 2011;11:142–51.CrossRefPubMedGoogle Scholar
  24. 24.
    Eggimann P, Garbino J, Pittet D. Epidemiology of Candida species infections in critically ill non-immunosuppressed patients. Lancet Infect Dis. 2003;3:685–702.CrossRefPubMedGoogle Scholar
  25. 25.
    Sobel JD, Kauffman CA, McKinsey D, Zervos M, Vazquez JA, Karchmer AW, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. Clin Infect Dis. 2000;30:19–24.CrossRefPubMedGoogle Scholar
  26. 26.
    Georgiadou SP, Tarrand J, Sipsas NV, Kontoyiannis DP. Candiduria in haematologic malignancy patients without a urinary catheter: nothing more than a frailty marker? Mycoses. 2013;56:311–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Kim J, Kim DS, Lee YS, Choi NG. Fungal urinary tract infection in burn patients with long-term foley catheterization. Korean J Urol. 2011;52:626–31.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    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. Med Mycol. 2012;50:529–32.CrossRefPubMedGoogle Scholar
  29. 29.
    Passos XS, Sales WS, Maciel PJ, Costa CR, Miranda KC, Lemos JA, et al. Candida colonization in intensive care unit patients’ urine. Mem Inst Oswaldo Cruz. 2005;100:925–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Noël T, Favel A, Michel-Nguyen A, Goumar A, Fallague K, Chastin C, Leclerc F, Villard J. Differentiation between atypical isolates of Candida lusitaniae and Candida pulcherrima by determination of mating type. J Clin Microbiol. 2005;43:1430–2.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bereczki L, Bartha N, Kocsubé S, Sóki J, Lengyel G, Tálosi G, et al. Fungaemia caused by Candida pulcherrima. Med Mycol. 2012;50:522–4.CrossRefPubMedGoogle Scholar
  32. 32.
    Drogari-Apiranthitou M, Anyfantis I, Galani I, Kanioura L, Daikos GL, Petrikkos G. Association between Candiduria and Candidemia: a clinical and molecular analysis of cases. Mycopathologia. 2017;182:1045–52.CrossRefPubMedGoogle Scholar
  33. 33.
    García-Agudo L, Galán F, García-Martos P, Carranza R, Rodríguez-Iglesias M. Utilidad de la espectrometría de masas en el diagnóstico microbiológico de la candiduria. Rev Iberoam Micol. 2016;33:58–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Marklein G, Josten M, Klanke U, Müller E, Horré R, Maier T, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry for fast and reliable identification of clinical yeast isolates. J Clin Microbiol. 2009;47:2912–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media B.V., part of Springer Nature 2017

Authors and Affiliations

  • Lidia García-Agudo
    • 1
  • Manuel Rodríguez-Iglesias
    • 2
  • Rafael Carranza-González
    • 3
  1. 1.Molde SykehusHelse Møre og RomsdalMoldeNorway
  2. 2.Hospital Universitario Puerta del MarCádizSpain
  3. 3.Hospital General La Mancha-CentroAlcázar de San Juan, Ciudad RealSpain

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