Eur J Clin Microbiol Infect Dis (2008) 27:201208

DOI 10.1007/s10096-007-0427-9

ARTICLE

Clinician response to Candida organisms in the urine

of patients attending hospital
S. C. A. Chen & Z. S. Tong & O. C. Lee & C. Halliday &
E. G. Playford & F. Widmer & F. R. Kong & C. Wu &
T. C. Sorrell

Received: 27 August 2007 / Accepted: 2 November 2007 / Published online: 4 December 2007
# Springer-Verlag 2007

Abstract The epidemiology of 54 episodes of candiduria

with respect to clinical risk factors, species of Candida and
physician response to the isolation of Candida in urine
were studied in an observational survey over 3 months.
Candida spp. were isolated from 4.7% of positive urine
cultures. Common predisposing conditions included antibiotic use (74.1%), urinary drainage devices (57.4%), surgery
(51.9%), intensive care unit (ICU) or high-dependency care
unit (HDU) admission (42.6%) and urinary tract (UT)
disease (18.5%). Upper UT infection was uncommon (n=
3). Of 65 Candida isolates, C. albicans predominated
(85.2%), followed by C. glabrata (27.8%) and other
Candida spp. (6.2%). All isolates were susceptible to
fluconazole, itraconazole, voriconazole, amphotericin and
caspofungin. Indwelling urinary catheters were removed in
76.2% of episodes. Antifungal therapy was initiated in

S. C. A. Chen (*) : C. Halliday : F. Widmer : T. C. Sorrell

Centre for Infectious Diseases and Microbiology
and the University of Sydney at Westmead, Westmead Hospital,
Darcy Road, Westmead,
NSW 2145 Sydney, Australia
e-mail: sharon.chen@swahs.health.nsw.gov.au
Z. S. Tong
Research Laboratory for Infectious Skin Diseases,
Department of Dermatology, Wuhan First Hospital,
Wuhan, Peoples Republic of China
S. C. A. Chen : O. C. Lee : C. Halliday : F. R. Kong : C. Wu
Centre for Infectious Diseases and Microbiology
Laboratory Services, Westmead Hospital,
Sydney, Australia
E. G. Playford
Infection Management Services, Princess Alexandra Hospital,
Brisbane, Australia

33.3% of cases independently of patient symptoms,

underlying disease or Candida colony count. Patients in
ICU/HDUs were significantly more likely to receive
antifungal agents than those outside these units (p<0.001).
Fluconazole was the most common drug prescribed
(77.8%). Clearance of candiduria occurred independently
of antifungal therapy (p=0.60). Physicians often did not
follow up a positive urine result for Candida. Efforts to
increase clinician awareness of current recommendations
for managing candiduria and further study to elucidate
specific risk factors in defined patient populations are
warranted.

Introduction
Candiduria is a common condition in hospitalised patients
[13]. Although there are few precise estimates of its
incidence, one large one-day, point prevalence survey of
positive urine cultures identified Candida spp. in nearly
10% of specimens [4]. Up to 30% of nosocomial urinary
tract (UT) infections are reportedly caused by Candida
[3, 5, 6]. Risk factors for candiduria include urinary drainage
devices, surgery, broad-spectrum antibiotics, diabetes mellitus and increased age [1, 2, 58]. The prevalence of
candiduria also varies with hospital setting, being most
common in intensive care units (ICUs) [6, 9].
Since its clinical significance is incompletely understood, candiduria presents a management dilemma for
physicians [1, 10], who may initiate treatment with
antifungal agents in the absence of evidence as to whether
Candida in urine represents colonisation or true infection.
To date, there are no reliable criteria for distinguishing
between colonisation and infection or, when present,
infection confined to the lower UT from that associated

202

with systemic involvement [6, 10]. The view by some

authors to regard high-grade candiduria (104 colonyforming units (cfu)/ml) to more likely be indicative of
upper UT candidiasis [1113] remains controversial.
Given that the indications for treating candiduria are
uncertain, the clinical response remains largely driven by
expert opinion or has been derived from deductive analyses
of small case series [6, 1416]. In particular, factors that
influence decisions regarding the investigation of candiduria
and when to initiate antifungal therapy remain unclear. The
choice of antifungal agent is also empirical. Although
logically guided by local epidemiology, species data are often
not available because hospital laboratories do not usually
speciate yeasts from urine. Systemic administration of the
azole drug, fluconazole, and the local instillation of amphotericin B are effective in the short-term eradication of Candida
from urine [1, 6, 15]. However, since certain non-albicans
Candida spp., in particular, C. glabrata, may be resistant or
less susceptible to azoles, periodic species identification of
Candida is relevant in order to develop empiric antifungal
treatment guidelines [15].
The purpose of this survey was to estimate the frequency
of candiduria in a large institution and to study the response
of physicians following the isolation of Candida in urine.
More specifically, we attempted to identify clinical and
microbiological factors that may have influenced management and outcome, and to address clinically relevant issues
that could improve patient care. To define the microbiology
of candiduria, we identified Candida isolates to their
species level and determined their in vitro susceptibility to
five antifungal agents.

Eur J Clin Microbiol Infect Dis (2008) 27:201208

disease; presence of and duration of risk factors, including

treatment within the preceding 30 days with antibacterial or
immunosuppressive agents, UT instrumentation (nephrostomies, cystoscopies, stent placements, intermittent urinary
catheterisation, IDC placement), recent (30 days) surgery
(non-urological and open urological); patient symptoms and
signs, including fever (temperature of >38C); urine
Candida colony count and culture results; radiological
(renal ultrasound and computed tomography [CT] scan) and
other microbiological data, including culture of Candida
spp. from body sites other than urine; if urine culture results
were recorded in the patients hospital charts and if followup microbiological tests were performed; complications
(e.g. pyelonephritis, candidaemia); treatment modality,
including discontinuing antibiotics and removing or changing IDCs; duration of stay in an ICU or high-dependency
care unit (HDU); and outcomes with regard the clearance or
persistence of candiduria.
Definitions
Candiduria was defined as the presence of 104 cfu/mL of
any Candida spp. in urine [7]. Persistence of candiduria was
defined as at least two consecutive urine cultures positive for
Candida. A second urine culture without evidence of
Candida was indicative of clearance. Invasive candidiasis
(IC) was defined by criteria consistent with published
guidelines [17]. Upper UT candidiasis was present if
pyelonephritis, fungal balls or other microbiological evidence of UT disease was evident. Candiduria was nosocomial if it occurred 48 hours after hospitalisation [8, 18].
Microbiological studies

Materials and methods

Candida species identification
Study design
An observational, prospective, laboratory-based survey of
patients with candiduria at our institution (an 850-bed
university and quaternary referral hospital) was undertaken
from June through August 2006. All inpatients and hospital
outpatients with a positive urine culture for Candida
organisms during the 3-month period were observed from
the time of detection of candiduria until discharge from
hospital or until death. No attempt was made to influence
patient management. Specimens collected by midstream
urine (MSU) techniques or via indwelling urinary catheters
(IDCs), including suprapubic catheters, nephrostomies and
ileal conduits, were eligible for inclusion. Surveillance
cultures for Candida are not routinely performed in the
hospital.
The following data were recorded: demographic information; patient location at time of candiduria; underlying

Quantitative urine cultures were performed using standard

laboratory methods. Colonies suspicious for Candida spp.
were identified using CHROMagar Candida (Dutec
Laboratories, Australia) plates according to the manufacturers guidelines. Isolates were then identified to their species
level with the RapID Yeast Plus system (Remel, KS).
In vitro susceptibility
Minimal inhibitory concentrations (MICs) of amphotericin
B (Bristol-Myers Squibb, Princeton, NJ), fluconazole
(Pfizer Australia, Ryde, Australia), itraconazole (Janssen
Research Foundation, Beerse, Belgium) and voriconazole
(Pfizer Australia) were determined by broth microdilution
in accordance with the National Committee for Clinical
Laboratory Standards (NCCLS) M27-A2 guidelines for the
susceptibility testing of yeasts [19]. Solutions of flucona-

Eur J Clin Microbiol Infect Dis (2008) 27:201208

zole, itraconazole and voriconazole were prepared as previously recommended [19]. C. parapsilosis ATCC 22019 and
C. krusei ATCC 6528 were the quality control strains for
each test run [19]. Susceptibility to caspofungin was
determined by E test (AB Biodisk, Solna, Sweden; concentration range 0.002 to 32 g/ml) in accordance with the
manufacturers protocol.
For broth microdilution experiments, MIC endpoint
readings were assigned as previously described using a
spectrophotometer (550 nm) [19, 20]. For azole drugs, the
MIC was defined as the lowest concentration corresponding
to 50% inhibition compared with growth in the control
(drug-free) well [19, 20]. For amphotericin B, the MIC was
the lowest concentration showing 100% growth inhibition.
Caspofungin MICs were read at 80% inhibition according
to the manufacturers procedure (AB Biodisk). Where ten
or more of a species was tested, the MIC50s and MIC90s
were calculated.
Statistical analysis
The observed frequency of candiduria over the study period
was estimated from the number of positive urine cultures
for Candida in relation to the total number of urine
specimens from which an organism was recovered. Descriptive statistics were used to summarise continuous
measures. The data were analysed using the Epi Info
version 6.0 statistical program (Centers for Disease Control
and Prevention, Atlanta, GA). Categorical variables were
compared using the chi-square or Fishers exact test. P
values of <0.05 were considered to be significant.

Results
Patient demographics and setting
Fifty-eight patients with a positive urine culture for
Candida were identified. Clinical and outcome data were
available for 54 patient episodes. Species identification and
susceptibility data were determined for 65 Candida isolates
from 58 urine specimens.
Candida was recovered in 4.7% (58 of 1,224) of positive
urine cultures. The median patient age was 66 years (range
5 days90 years) with 31 (57.4%) patients aged 65 years.
Thirty-eight (70.4%) episodes affected females. The majority of episodes (50; 92.6%) occurred in hospitalised
inpatients and 41 (82%) of these were nosocomial. Overall,
13 (24.1%) episodes were outpatient-acquired. The largest
proportion of episodes occurred in an ICU and/or HDU (23;
42.6%), followed by medical (18; 33.3%) and surgical (9;
16.7%) wards.

203

Risk factors and clinical features

Receipt of broad-spectrum antibiotics (mean duration
14 days prior to the detection of yeast) was the most
commonly recognised risk factor (74.1% of patients),
followed by surgery (51.9%) and ICU and/or HDU
admission (42.6%; mean duration of stay 15.8 days prior
to candiduria) (Table 1). A urinary drainage device was
present in 57.4% of cases, with intermittent catheterisation
(14.8%) having been undertaken in a subset of these
patients within an average of 3.5 days (range 213 days)
prior to candiduria. The mean time from the insertion of an
IDC to candiduria was 12.4 days (range 272 days). The
receipt of immunusuppressive therapies was rare (<0.2%).
Twenty-seven (50%) patients had 3 risk factors. The
majority of patients had underlying medical conditions,
including 16.7% with diabetes mellitus and 18.5% with preexisting UT disease (Table 1). All six patients with nonurological malignancy had solid organ cancers.
Urinary symptoms were infrequent (eight patients,
14.8%) but fever and leucocytosis were present in 44
(81.5%) and 32 (59.3%) cases, respectively; most of these
patients had multiple serious illnesses. Six patients had
concomitant bacteremia but no patient developed IC,
including candidaemia. Three of 26 patients in whom renal
ultrasound or CT studies were performed demonstrated
features of pyelonephritis but fungal balls were not
identified in any case.
Microbiology studies
Urine analysis revealed pyuria (>10 white blood cells/high
power field) in 39 (72.2%) episodes. Yeasts were visualised
in all and Candida spp. was recovered in pure culture in 53
(98.2%) instances. The colony count was 105 cfu/ml in 27
episodes (50%), 104105 cfu/ml in seven cases (13%) and
104 cfu/ml in 20 (37%) cases. Only two patients had
Candida isolated from a body site other than urine
preceding candiduria.
Of 65 Candida isolates, the predominant species was
C. albicans (46 (85.2%) cases), followed by C. glabrata
(15 or 27.8% of cases). C. parapsilosis accounted for two
episodes, whilst C. tropicalis and C. kefyr were each
recovered in a single instance. In five episodes (8.6%),
C. albicans was isolated together with C. glabrata. The
identification of C. albicans using CHROMagar Candida
medium (Dutec Laboratories) was concordant in 100% of
cases with the RapID Yeast Plus system (Remel). However,
the latter was required to distinguish between C. glabrata,
C. parapsilosis and C. kefyr. All isolates were susceptible
to amphotericin B and caspofungin and no resistance
among Candida spp., including C. glabrata, to fluconazole,
itraconazole and voriconazole was observed (Table 2).

204
Table 1 Underlying risk
factors and co-morbidities for
54 episodes of candiduria

ICU=intensive care unit;

IDC=indwelling urinary
catheter; HDU=highdependency care unit
a
Some patients had >1 risk
factor and/or co-morbidity

Table 2 Minimum inhibitory

concentrations (MICs) of 65
urine Candida isolates to five
antifungal agents

Eur J Clin Microbiol Infect Dis (2008) 27:201208

Characteristica
Risk factor
Antibiotics 30 days
Surgery 30 days
- gastrointestinal
- urological
ICU and/or HDU admission
IDC
Intermittent urinary catheterisation
Urinary stent
Trauma
Renal transplantation
Prematurity
Co-morbidity
Malignancy (non-urological)
Diabetes
Urinary tract disease
- Neurogenic bladder
- Stones/other obstructive lesions
- Recurrent infection
- Intrinsic renal disease

Species (no. of strains)

C. albicans (46)

C. glabrata (15)

C. parapsilosis (2)

C. tropicalis (1)

C. kefyr (1)

Total (65)
a

MIC at which 50% of the

isolates were inhibited
b
MIC at which 90% of
the isolates were inhibited

Antifungal agent

Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole
Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole
Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole
Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole
Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole
Caspofungin
Itraconazole
Voriconazole
Amphotericin
Fluconazole

No.

% of episodes

40
28
10
4
23
21
8
2
5
1
1

74.1
51.9
18.5
7.4
42.6
38.9
14.8
3.7
9.3
1.9
1.9

6
9
10
5
4
4
1

11.1
16.7
18.5
9.3
7.4
7.4
1.9

MIC (g/ml)
Range

MIC50a

MIC90b

0.0120.064
0.0310.125
0.0310.063
0.0310.25
0.1250.5
0.0470.094
0.0312
0.0310.063
0.0630.5
0.1252
0.1250.25
0.0310.063
0.031
0.063
0.5
0.032
0.5
0.031
0.25
1
0.016
0.063
0.031
0.25
0.063
0.0120.25
0.0312
0.0310.063
0.0310.5
0.0632

0.032
0.031
0.031
0.125
0.125
0.064
0.125
0.031
0.25
2

0.047
0.063
0.031
0.25
0.5
0.094
0.5
0.063
0.25
2

0.032
0.031
0.031
0.125
0.125

0.094
0.125
0.031
0.25
2

Eur J Clin Microbiol Infect Dis (2008) 27:201208

205

Clinical approach to candiduria

Urine culture results were noted in the patient medical
charts in 35 of 54 (64.8%) cases. Physicians in ICU/HDUs
were more likely to record results than those working in
non-ICU/HDU areas, although this was not statistically
significant (odds ratio [OR] 3.0, 95% confidence interval
[CI], 0.8, 12.1; p=0.08). Antifungal therapy was initiated in
18 cases (33.3%) or 51% instances where urine results were
noted. Among the 21 patients with IDCs at the time of
candiduria, 16 (76.2%) had the IDC removed or changed;
seven of these received antifungal therapy. Antibacterial
agents were rarely discontinued (one subject).
To assess factors which may have influenced physician
decision to initiate antifungal therapy, we compared
selected characteristics of treated and untreated patients
(Table 3). Most patients in whom treatment was initiated
had no urinary symptoms. Clinicians were significantly
more likely to prescribe antifungal agents for patients in
ICU/HDUs compared with patients located outside these
units (OR 10.5, 95% CI 2.4, 51.4; p<0.001; Table 3).
Treatment was independent of IDC placement, systemic
symptoms, underlying cancer, diabetes, Candida colony
count or recovery of C. glabrata (Table 3). All 18 of the
treated patients had pyuria. The single renal transplant
recipient received antifungal therapy. Antifungal agents
used comprised oral or intravenous fluconazole (14
patients; 77.8%) with an average duration of 7.2 days,
and voriconazole, caspofungin, fluconazole pessaries and
amphotericin B bladder irrigation (one instance each).
Candiduria resolved in 21 of 25 (84%) patients from
whom subsequent urine specimens were submitted (7
14 days after the first isolation of Candida). Eleven of 12
patients who received antifungal treatment demonstrated
clearance of candiduria compared with 10 of 13 receiving
no antifungal drugs (p=0.60). Of the 21 patients with an
IDC, follow-up urine specimens were submitted for 11.
There was clearance of candiduria in 5 of 8 patients who
had their IDC removed (all received antifungal agents) but

also in three patients whose IDCs were left in situ (two had
antifungal therapy). Clearance of candiduria was independent of urine colony count (data not shown).

Discussion
Despite several epidemiological surveys of candiduria,
factors that would assist evidence-based management
decisions remain undefined. We therefore focussed our
study on the clinical approach to candiduria. The results
indicate that there were insufficient attempts to verify the
presence of infection, as distinct from colonisation, or to
base decisions for prescribing antifungal drugs on patient
risk factors. The only factor predictive of antifungal
treatment was patient location in an ICU/HDU. Given that
many candiduria episodes resolved regardless of antifungal
therapy and that we were unable to identify factors that
predicted clearance, a systematic approach to improving
patient care is warranted.
The finding of Candida in 4.7% of positive urine
cultures over the study period was not trivial, although it
was lower than in a multi-centre European study (9.4%) [4].
Direct comparison of candiduria rates between institutions
is difficult, due to the lack of standardised denominator data
and case-mix differences. One review has estimated 25,000
candiduria cases occurring annually in the US ICUs but this
does not include the burden among non-ICU patients [21];
furthermore, candiduria is not restricted to hospital inpatients. In the current survey, 24.1% of cases affected
outpatients, suggesting the need for a separate study of this
patient group focussing on risk factors and prevention.
As in previous surveys, urinary catheterisation was
common [1, 7, 22]. The duration of catheterisation is also
relevant, with intervals of 612 days post-IDC-insertion
reported to precede candiduria [8, 23, this study], although in
one study, 69% episodes developed after 3 days following
IDC placement [5]. Many (40%) episodes occurred in an
ICU/HDU (vs. 2035.3% elsewhere [7, 24]). Whilst ICU

Table 3 Comparison of treated and untreated patients with candiduriaunivariate analysis

Characteristic (total no.)

Treated (n=18)

Untreated (n=36)

Odds ratio

p value

ICU/HDU admission (23)

Cancer (6)
Diabetes mellitus (9)
IDC-associated (21)
Fever (44)
Non-albicans Candida spp. (19)
Candida colony count >105 cfu/mL (27)

14
2
5
10
17
8
11

9
4
4
8
27
11
16

10.5
0.70
3.08
2.0
5.67
2.62
1.96

<0.001
1.0
0.14
0.24
0.14
0.17
0.39

ICU=intensive care unit; HDU=high-dependency care unit; IDC=indwelling urinary catheter

206

admission is an independent predictor of candiduria in renal

transplant recipients, this is less well-documented for general
hospital patients [1, 24]. There were fewer patients with
diabetes mellitus (16.7% vs. 3945%) or cancer (11% vs.
20%) than previously noted [1, 2, 16]. Possible explanations
for these differences include the use of different criteria to
define candiduria. While others used a colony count
103 cfu/ml [1, 16], we chose 104 cfu/ml for case selection,
since the likelihood of true infection is considered to be the
greatest when counts are above this level [25]. Moreover,
counts of 104 cfu/ml have been associated with a high
Candida colonisation index [12, 13], which, in turn, predicts
the development of IC in ICU patients [26, 27]. Despite
counts of 105 cfu/ml in 50% of our patients, upper UT
candidiasis was uncommon and no patient developed
candidaemia. Candidaemia has been previously noted to
complicate 1.05.7% of cases of candiduria [1, 5].
Because the study was observational, we were unable to
determine the reason(s) behind the initiation of urine
cultures. However, we were intrigued that culture results
were recorded in the medical charts of only 64.5% of
patients; only 70% of these patients had follow-up urine
tests. This may reflect failure to note the laboratory report
or a judgment that the culture was not clinically important.
It is also possible that, in some cases, the results were
accessed electronically but not written down in the patient
chart. Ultrasound and CT studies were performed in 48% of
patients but often for reasons other than suspected infection.
Given the substantial costs relating to technician and
nursing staff hands-on time in handling urine specimens,
efforts should be made to increase clinician awareness of
current guidelines advising the repeat of urine cultures to
confirm candiduria, followed by risk factor assessment and
evaluating patients for clinical disease, prior to initiating or
withholding therapy [15]. This is important because a main
issue regarding candiduria is the lack of diagnostic tools to
distinguish infection from colonisation or, indeed,
upper from lower UT infection. Furthermore, it is unlikely
that newer diagnostic assays for fungal infection, such as
the D-glucan [28] or PCR-based assays, will solve this
dilemma, as the issue is not one of test sensitivity but of
defining what constitutes infection. Thus, education programs directed at providing feedback of test results to
clinicians, possibly the expanded use of ultrasound or CT/
MRI to establish upper UT infection, and changing
physician behaviour are required for optimal medical care.
An additional consideration for further study is the
targetting of specific populations that may be at a higher
risk for developing Candida UT infection, or for developing complications, including patients with diabetes (16.5%)
and pre-existing UT disease (18.5%) or ICU patients (40%)
and outpatients (24.1%) [this study]. Furthermore, patients
in long-term care facilities frequently have the placement of

Eur J Clin Microbiol Infect Dis (2008) 27:201208

IDCs and, yet, there are few data on the incidence or natural
history of candiduria in this setting.
The treatment of candiduria with antifungal agents is
usually reserved for patients with IC or those at high risk
for infection (e.g. neutropenic patients), with little to
support their use in asymptomatic patients [15]. Nevertheless, one-third of patients received antifungal drugs. While
this is less than that noted previously (60.2%; [7]), we
identified no factor that influenced this practice, except that
ICU/HDU physicians were more likely to prescribe
antifungal drugs (Table 3). Whether this reflects apprehension over critically ill patients or the greater likelihood of
having documented urine results is uncertain. Conversely,
treatment was independent of colony count, contrasting
with one study where patients with counts of >104 cfu/ml
were significantly more likely to receive antifungal drugs
[7]. The practice of the withholding of antifungal agents
(66.7% of cases) is supported by finding that candiduria
clearance rates were independent of antifungal receipt.
Whilst previous reports note superior short-term clearance
rates with fluconazole therapy [1, 16, 24], the analysis of
longer-term eradication rates revealed no benefit [16]. We
were unable to assess the effect of IDC removal as an
independent factor due to the co-administration of antifungal agents. Current guidelines recommend IDC removal in
all cases of candiduria [15].
Our current laboratory protocol reports yeasts in urine as
either C. albicans or non-albicans Candida spp.
according to colour on CHROMagar Candida medium
(Dutec Laboratories). C. albicans was the predominant
species in urine, followed by C. glabrata [1, 7, 16, this
study] and resistance to azoles was not observed. Based on
the study results, it remains appropriate to continue this
practice, since this provides clinically useful information as
to whether an isolate is likely to be susceptible to
fluconazole. Routine species identification by the RapID
Yeast Plus system (Remel) is precluded by high costs
(AUD $10/isolate). The above protocol, however, may be
unsuitable in countries such as India, where non-albicans
Candida spp. comprise 5080% of urine Candida isolates
[5, 29, 30]. Indeed, C. tropicalis was the most common (up
to 40%) species in two surveys [29, 30]. Although not
recovered in our study, C. tropicalis candiduria is notable
for its high treatment failure rates and association with case
clusters [16, 31, 32]. The periodic monitoring of species
distribution and susceptibility is indicated to identify
potentially fluconazole-resistant Candida, (e.g. C. glabrata),
as this has implications for empiric antifungal therapy. Our
study further demonstrates that fluconazole use is appropriate
where antifungal therapy is prescribed. The few alternative
systemic antifungals, including voriconazole [33] and
caspofungin [34], do not achieve the high urine concentrations required to eradicate infection, precluding their

Eur J Clin Microbiol Infect Dis (2008) 27:201208

immediate consideration if therapy is required. However,

both of these drugs may be effective in treating UT Candida
infection [35].
In conclusion, physicians often did not evaluate patients
with candiduria for significant infection or initiate antifungal treatment according to patient risk factors. Current
laboratory practice of reporting yeasts from urine as C.
albicans or non-albicans Candida spp. remains useful
but the periodic monitoring of trends in species and in vitro
susceptibility is indicated. Antifungal therapy did not
impact on the likelihood of the clearance of candiduria.
More efforts through increased education and periodic
audits to increase clinician awareness of current management recommendations are warranted.

Acknowledgements We thank Mr. Tom Olma, Mr. Eulogio Mendes

and Mrs. Roshni Sudhaker for their assistance in identifying colonies
suspicious for Candida spp. in urine.

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