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Hospital-associated funguria: analysis of risk factors, clinical presentation and outcome
M Carvalho1, C M Guimarães, J R Mayer
1Department of Internal Medicine, Section of Infectious Diseases and Laboratory of Mycology, Universidade Federal do Paraná, Brazil. carvalho@mais.sul.com.br
Abstract:
Fungal urinary tract infections are an increasing problem in hospitalized patients. Funguria may be a result of contamination of the urine specimen, colonization of hte urinary tract, or may be indicative of true invasive infection. In this study, we report the risk factors, clinical features, treatments and outcome in a group of 68 hospitalized patients (adults and children) with fungal isolates recovered from 103 urinary samples. Underlying medical conditions were present in most patients. In the pediatric group, urinary tract abnormalities (86%) and prematurity (19%)accounted for the majority of the cases. Diabetes mellitus (28%), nephrolithiasis, and benign prostatic hyperplasia were the most common diseases in adults. Indwelling urethral catheters were noted in 38% of the pediatric patients and in 43% of adults during hospitalization. Candida albicans strains were responsible for 97% and 75% of positive cultures in children and adults, respectively. Symptoms such as fever, dysuria, frequency and flank pain were generally absent in both groups. Fluconazole was the most frequent antifungal utilized (61%) in children and ketoconazole in the adult group (42%). Removing the urinary catheter was attempted in 6 pediatric patients (29%) and in only 8 adults (17%). One patient (4%) in the pediatric group died compared to 10 in the adult group (21%, p=0.04). Successful diagnosis and treatment of funguria depends on a clear understanding of the risk factors and awareness of fungal epidemiology.
Insights
Fungal urinary tract infections (funguria) are common in hospitalized patients, often linked to underlying conditions and catheters. Candida albicans is the primary cause, with treatment varying by age group.
Area of Science:
- Infectious Diseases
- Mycology
- Urology
Background:
- Fungal urinary tract infections (funguria) are an increasing concern in hospitalized populations.
- Funguria can represent contamination, colonization, or invasive infection, necessitating careful diagnosis.
- Hospitalized patients, particularly those with underlying conditions, are at higher risk.
Purpose of the Study:
- To investigate risk factors, clinical presentations, treatments, and outcomes of funguria in hospitalized adults and children.
- To identify common fungal pathogens and their prevalence in urinary samples.
- To analyze the effectiveness of different antifungal treatments and interventions.
Main Methods:
- Retrospective analysis of 103 urinary samples from 68 hospitalized patients (pediatric and adult).
- Data collection included patient demographics, underlying medical conditions, presence of indwelling catheters, clinical symptoms, and treatment regimens.
- Identification of fungal isolates and analysis of treatment outcomes and mortality rates.
Main Results:
- Underlying medical conditions were prevalent in most patients. Pediatric cases often involved urinary tract abnormalities and prematurity, while adults had diabetes, nephrolithiasis, and benign prostatic hyperplasia.
- Indwelling urethral catheters were common (38% pediatric, 43% adult). Candida albicans was the predominant species (97% pediatric, 75% adult).
- Symptoms were generally absent. Fluconazole and ketoconazole were common treatments. Mortality was higher in adults (21%) than in children (4%, p=0.04).
Conclusions:
- Funguria diagnosis and management require understanding patient-specific risk factors and local fungal epidemiology.
- Prompt identification and appropriate treatment, alongside catheter removal when feasible, are crucial for favorable outcomes.
- The study highlights differences in risk factors, pathogens, and outcomes between pediatric and adult funguria cases.
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