title: Candiduria in critically ill patients admitted to intensive care medical units.
abstract: BACKGROUND
  The purpose of this study was to determine the incidence of candiduria in critically ill patients admitted to intensive care medical units (ICUs), to identify risk factors for candiduria and to assess the frequency distribution of different Candidaspp.
  
  
  METHODS
  This was a prospective cohort observational and multicenter study. A total of 1,765 patients older than 18 years of age who were admitted for at least 7 days to 73 medical-surgical ICUs of 70 Spanish hospitals were included in the study. Urine cultures were performed once a week.
  
  
  RESULTS
  In 389 patients (22%), Candidaspp. in one or more urine samples were isolated. In the multivariate analysis, independent risk factors for candiduria included: age >65 years, female sex, length of hospital stay before ICU admission, diabetes mellitus, total parenteral nutrition, mechanical ventilation and previous use of antimicrobials. Candida albicanswas recovered in 266 cases (68.4%), followed by C. glabrata(32 cases, 8.2%) and C. tropicalis(14 cases, 36%). Previous use of antifungal agents was the only risk factor for the selection of Candidanon-albicans candiduria (OR 2.64, 95% CI 1.35-5.14, P=0.004). In-hospital mortality was 48.8% in patients with candiduria compared to 36.6% in those without candiduria ( P<0.001). Significant differences were also found for ICU mortality (38.% vs. 28.1%, P<0.001).
  
  
  CONCLUSIONS
  Twenty-two percent of critically ill patients admitted for more than 7 days in the ICU developed candiduria. C. albicanswas the most frequent causative pathogen. Previous use of antifungals was the only risk factor for the selection of Candidanon-albicans.
authors.affiliation: Department of Intensive Care Medicine, Hospital Universitari del Mar, Paseo Marítimo 25-29, 08003, Barcelona, Spain. FAlvarez@imas.imim.es
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Juan
authors.initials: J
authors.lastname: Nolla-Salas
authors.forename: Cristobal
authors.initials: C
authors.lastname: León
authors.forename: Mercedes
authors.initials: M
authors.lastname: Palomar
authors.forename: Ricard
authors.initials: R
authors.lastname: Jordá
authors.forename: Nieves
authors.initials: N
authors.lastname: Carrasco
authors.forename: Felipe
authors.initials: F
authors.lastname: Bobillo
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D002175:Candida / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D015169:Colony Count, Microbial; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013045:Species Specificity; D014556:Urine / Q000382:microbiology*