Predictive factors and prognostic value of candiduria in critically-ill patients with solid and hematological malignancies.

Abstract

To investigate the epidemiology of candiduria in critically-ill patients with solid/hematological malignancies and to assess its predictive factors and prognostic value. All adult patients with confirmed solid/hematological malignancy admitted in the intensive care units (ICUs) for more than 48h were retrospectively included. Urine cultures were sampled on admission and then whenever signs of sepsis were identified. Two groups were compared: (candiduria (+)) and (candiduria (-)). One-hundred-seventy-three patients were included. Solid cancer was the underlying oncological disease for 147 patients (85%) while 26 patients (15%) had hematological malignancies. Twenty-nine patients (16.8%) were diagnosed with candiduria, and 31 urinary samples grew Candida spp. Candida spp represented 55.8% of the total urinary isolates. Fourteen isolates (45.2%) of Candida albicans were identified. Among the 17 non-albicans isolates, Candida tropicalis was the most predominant (41.9%). Six patients (3.5%) had candidemia with no significant difference between candiduria(+) and candiduria(-) groups (respectively, 6.9% and 2.8%; p=0.264). In multivariate analysis, previous exposure to quinolones (OR=3.8, CI95% [1.4-8.3]; p=0.008), mechanical ventilation (OR=4.1, CI95% [1.1-14.7]; p=0.034) and renal replacement therapy (OR=3.5, 95%CI [1.2-9.7]; p=0.017) were identified as independent factors predicting candiduria. Candiduria was associated with significantly higher ICU-mortality after adjusting for SAPSII score on admission (OR=2.9 CI95% [1.3-6.8]; p=0.009). Candiduria is common in cancer critically-ill patients. We reported an increased rate of non-albicans species, over albicans species. Patients with candiduria had higher ICU mortality, probably related to higher frailty and clinical severity.