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The outcome of candiduria in pediatric patients
1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.
Insights
Candiduria (Candida in urine) in critically ill children can signal invasive fungal infection, especially in neonates or those with catheters. High-risk patients require careful evaluation for disseminated candidiasis.
Area of Science:
- Medical Mycology
- Pediatric Infectious Diseases
- Critical Care Medicine
Background:
- Candiduria in critically ill pediatric patients poses management challenges due to limited data on its natural history and link to disseminated candidiasis.
- Understanding candiduria's significance is crucial for timely diagnosis and treatment of invasive fungal infections in vulnerable children.
Purpose of the Study:
- To investigate the outcomes of candiduria in pediatric patients.
- To identify predictors of disseminated candidiasis originating from urinary tract infections in children.
Main Methods:
- Retrospective review of medical records for 54 pediatric patients with candiduria.
- Analysis of urine collection methods, Candida colony counts, extragenital cultures, antifungal treatment, and clinical outcomes.
Main Results:
- Six out of 54 (11%) patients exhibited systemic Candida infection.
- Candiduria was the initial indicator of disseminated candidiasis in only two patients.
- Invasive infection risk was higher in neonates, those with central venous catheters, or on immunosuppressive therapy.
- Urine Candida colony counts did not reliably predict invasive disease.
Conclusions:
- Candiduria generally has low clinical significance in otherwise healthy pediatric patients.
- In high-risk pediatric populations, candiduria warrants thorough investigation for disseminated candidiasis, irrespective of perineal infection or urinary catheter presence.
Abstract:
The presence of Candida in the urine of a seriously ill, pediatric patient presents a management problem because of a lack of information concerning the natural history of candiduria and its relationship to disseminated candidiasis. In this retrospective study, the outcome of candiduria was examined in a group of 54 pediatric patients to determine any predictors of disseminated candidiasis. Medical records were reviewed to identify urine collection methods, Candida colony counts, results of cultures from other body sites, antifungal therapy, and clinical course. Six (11%) of the 54 patients had evidence of systematic Candida infection. In only two of these patients was candiduria the first evidence of disseminated candidiasis. Invasive infection was associated with candiduria more frequently in neonates and patients with central venous catheters and/or immunosuppressive therapy. Urine colony counts were not helpful for assessing the risk of invasive disease. Candiduria appears to be of little consequence in patients who are generally healthy. However, candiduria in high-risk patients, even in the presence of perineal candidal infection or an indwelling urinary catheter, should prompt a careful evaluation for disseminated infection.