The effect of current management on morbidity and mortality in hospitalised adults with funguria.
BACKGROUND
To compare morbidity and mortality in inpatients with asymptomatic funguria between those treated and those observed for funguria.


METHODS
Retrospective analyses were performed in 149 consecutive adult tertiary care inpatients with asymptomatic funguria. The primary endpoints were death, length of hospitalisation and progression to invasive fungal infection (IFI).


RESULTS
Of the 149 subjects, 70% were female, 55% were >65 years, recent antibiotic and urinary catheter use occurred in >70%, diabetes in 32%, recent ICU admission in 29%, and concomitant bacteriuria in 28%. Forty-seven percent did not receive active intervention. Of the remainder, 46% were managed by controlling or eliminating risk factors for funguria or progression to IFI; fluconazole or amphotericin B were used to treat the other 54%. Fourteen percent died and 2.7 % progressed to IFI, with no significant difference between the treated versus observed groups for either endpoint (p>0.2). Median length of hospitalisation was significantly greater in the treated group (p<0.01); multivariate analysis demonstrated an exclusive relationship to the greater number of risk factors present in the treated group.


CONCLUSIONS
Asymptomatic funguric patients who were managed with risk reduction and/or antifungal therapy were older, had more risk factors for funguria and subsequent progression to IFI, and had a longer hospital admission than those managed with observation. Treatment of asymptomatic funguria with risk reduction and/or antifungal therapy did not impact adult inpatient morbidity or mortality in this review; rather, the presence of multiple risk factors for funguria or IFI appeared to serve as a 'sickness indicator'.


CONCLUSIONS
In this study, we found that treatment for asymptomatic funguria in hospitalised adults did not impact morbidity or mortality. Rather, the presence of multiple risk factors for funguria or IFI correlated with a longer duration of hospitalisation, suggesting that funguria may be a 'sickness indicator', similar to bacteriuria in the elderly.
Simpson
Christine
C
Department of Medicine, University of Alberta, 2F1.13 Walter C. Mackenzie Health Sciences Centre, 8440-112 Street, Edmonton, Alta., Canada T6G 2R7.
Blitz
Sandra
S
Shafran
Stephen D
SD
D000368:Aged; D000416:Alberta / Q000453:epidemiology; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014546:Urinary Catheterization / Q000009:adverse effects
D000935:Antifungal Agents; D000666:Amphotericin B