Evaluation of a Novel Laboratory Candiduria Screening Protocol in the Intensive Care Unit

Figures & data

Figure 1 The schematic of the candiduria screening protocol designed in this study.

Figure 2 The interval times from ICU admission to confirmed candiduria by screening protocol and traditional pathway (historical control) are similar (P = 0.254).

Table 1 The Characteristics of the Patients Enrolled in This Study (n=139)

Characteristics	Intensive Care Unit Patients, N (%)		P value
	Candiduria (n = 24)	Non-Candiduria (n = 115)
Age, years	69.58±18.99	69.58±20.64	0.4385
Female gender	14 (58.33)	34 (29.57)	0.0070*
Basic conditions
SOFA score^a	5.83±3.10	6.69±3.17	0.3955
Malignant tumor	6 (25.00)	22 (19.13)	0.5143
Diabetes	10 (41.67)	24 (20.87)	0.0311*
Pneumonia	20 (83.33)	32 (27.83)	<0.0001*
Systematic infection	4 (16.67)	22 (19.13)	>0.9999
Respiratory failure	11 (45.83)	38 (33.04)	0.2329
Cardiac dysfunction	13 (54.17)	39 (33.91)	0.0622
Liver dysfunction	3 (12.50)	24 (20.87)	0.4116
Renal dysfunction	2 (8.33)	32 (27.83)	0.0648
Infarction/hemorrhage	10 (41.67)	12 (10.43)	0.0004*
Surgical morbidities	4 (16.67)	40 (34.78)	0.0956
Outcomes
Dead in hospital	12 (50.00)	19 (16.52)	<0.0001*
ICU stay length (median, range)	21 (17–98)	10 (1–108)	0.0002*

Note: *P < 0.05.

Abbreviation: ^aSOFA, sequential organ failure assessment.

Figure 3 Candida species distribution in groups of patients identified by screening protocol and historical control. Percentage of C. albicans was higher in the screening protocol group than the historical control group. However, the difference was not significant.

Table 2 Antifungal Susceptibility Testing Results for Common Candida Species Causing Candiduria Reviewed in This Study (n=24)

Organism (n)	Antifungal Agent	MIC Range (mg/L)	No. of Strains
			Susceptible	%S-DD/I^a	Resistant
C. albicans (12)	Fluorocytosine	≤2	12	0	0
	Fluconazole	≤2	12	0	0
	Voriconazole	≤0.12	12	0	0
	Itraconazole	≤0.06 to >2	10	1	1
	Amphotericin B	≤0.25 to 1	12	0	0
	Caspofungin	≤0.12 to 1	3	8	1
C. tropicalis (4)	Fluorocytosine	≤2	4	0	0
	Fluconazole	≤2 to >64	3	0	1
	Voriconazole	≤0.12 to 2	3	0	1
	Itraconazole	=0.25 to >2	0	2	2
	Amphotericin B	≤0.25 to 2	3	0	1
	Caspofungin	≤0.12 to 1	2	1	1
C. glabrata (4)	Fluorocytosine	≤2	4	0	0
	Fluconazole	≤2 to 64	1	2	1
	Voriconazole	≤0.12 to 0.25	4	0	0
	Itraconazole	0.12 to 1	1	1	2
	Amphotericin B	0.5 to 1	4	0	0
	Caspofungin	0.25 to 0.5	0	2	2
C. parapsilosis (4)	Fluorocytosine	≤2	4	0	0
	Fluconazole	≤2 to 8	3	0	1
	Voriconazole	≤0.12	4	0	0
	Itraconazole	0.12 to 0.25	2	2	0
	Amphotericin B	0.5	4	0	0
	Caspofungin	≤0.12 to 1	4	0	0

Abbreviations: ^aS-DD, susceptible dose dependent; I, intermediate.

Table 3 Characteristics of Multisite Colonization for the 24 Candiduria Patients Identified in This Study

Characteristics	No. of Patients (%)^a
Multisite colonization	17 (70.83)
Same Candida species in urine and sputum	7 (29.17)
Sputum culture positive before urine	10(45.83)
Urine culture positive before antifungal therapy	14 (58.33)
Evidence of invasive candidiasis^b	4 (16.67)

Notes: ^aCalculating percentages, the denominator was the 24 candiduria patients; ^b3 with positive blood cultures and 1 with positive peritoneal fluid culture.