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

• Published in: Journal de mycologie médicale Vol. 33; no. 1; p. 101353
• Main Authors: Chaari, Anis, Munir, Ahmed, Sharaf, Amr, Khairy, Amira, Kauts, Vipin, Erdem, Hakan
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.03.2023
• Subjects: Adult; Candida; Candidemia; Candidiasis - drug therapy; Candiduria; Critical Illness; Hematologic Neoplasms - complications; Hematologic Neoplasms - epidemiology; Humans; Intensive care; Intensive Care Units; Prognosis; Retrospective Studies; Risk Factors; Urinary Tract Infections - complications; Urinary Tract Infections - epidemiology; Candiduria; Intensive care; Prognosis; Candidemia
• ISSN: 1156-5233; 1773-0449
• DOI: 10.1016/j.mycmed.2022.101353

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 48 h 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.