Candidemia Attributed to a Urinary Tract Source: Retrospective Cohort Study of Risk Factors, Clinical Profiles,...

Urinary-source candidemia is an uncommon but clinically relevant form of invasive candidiasis, often underrecognized and poorly characterized in the literature.

Retrospective single-center study of adult patients with candidemia attributed to a urinary source between 2019 and 2023. Eligible cases were identified using predefined attribution criteria, requiring microbiologically confirmed Candida spp. bloodstream infection with significant candiduria by the same species, in the absence of an alternative clinically plausible source.

Among 526 positive blood cultures, 26 fulfilled the predefined criteria for urinary tract source attribution. The median age was 74 years. Most patients had a nephro-urological history, with frequent chronic kidney disease (15, 57.7%), obstructive uropathy (19, 73.1%), indwelling urinary devices (21, 80.8%) and recent urological procedures (19, 73.1%). Type 2 diabetes was present in 50% of patients (13), most receiving SGLT2 inhibitors. The majority presented with fever (23, 88.5%), and sepsis was frequent (14, 53.8%). Urinary symptoms were present in only half of the patients (14, 53.8%). Candida albicans was the most frequent isolate (13, 50%); followed by Candida glabrata (8, 30.8%) and Candida parapsilosis (5, 19.2%), both showing high rates of elevated fluconazole MICs. Empirical therapy was often discordant with final susceptibility. Combination antifungal therapy was used in 26.9% (7). Attributable mortality was 23.1% (6 deaths). Independent predictors of mortality included type 2 diabetes, Barthel Index < 50, therapeutic failure and septic shock.

Candidemia with a presumed urinary tract source primarily affects frail patients with urological comorbidities, often presents with non-specific symptoms and is associated with significant morbidity and mortality. Combination antifungal therapy may be beneficial in selected cases. Early recognition and individualized management are essential to improve outcomes.