Candida Albicans Versus Non Albicans Candiduria in the ICU Setting: Evaluation of Risk Factors

Abstract

1.1.Background:The indiscriminate use of antibiotic is increasing the prevalence of candiduria worldwide, especially in the ICU setting. Limited studies describe the risk factors associated with candiduria depending on their species. 1.2.Objective: This study aims to speciate candida isolated from patients with candiduria admitted in the ICU and evaluate the risk factors associated with albicans vs non albicans candiduria. 1.3.Material and method: The risk factors were evaluated in 60 yeast isolates using Fisher’s exact test (two-tailed) and Odd’s ratio with 95% confidence interval. 1.4.Result:The non-albicancandidaspecies isolated were C. tropicalis (14), C. glabrata (11), C. krusie (5) and C. parapsilosis (10). Although there was no significant difference between risk factors associated with albicans vs non-albicanscandida spp., the risk of non-albicans candiduria increased by 3 folds with increasing age(>50yrs.) OR (95%CI) 3.3158 (1.045-10.8693) and by 6 folds in patients with history of antibiotic intake in ICU OR (95%CI) 6.3521 (0.3339-120.8452). Non-albicans candiduria was significantly associated with presence of more pus cells (11-30cells/hpf) P= 0.0002; while C. albicans candiduria was significantly present in patients with < 10 puscells/hpf, P= 0.0001. Pseudophyphae were significantly less in non-albicans candiduria (P= 0.0113). Use of carbapenems, tigecycline and fluoroquinolones were significantly associated with non-albicans candiduria (P= 0.034; 0.0057; 0.003 respectively). 1.5.Conclusion:The risk of acquiring non-albicanscandiduria is more than albicans despite having same risk factors. Non albicans candiduria has become more prevalent cause of nosocomial candiduria in the ICUs may be due to the frequent use of antibiotics like fluoroquinolones in the ICU patients. Further studies are required to assess risk factors associated with different candida spp. to manage candiduria in ICU patients.