Factors associated with death in candiduria

Abstract number: 1134_01_200

Paul N., Mathai E., Abraham O.C., Michael J.S., Mathai D.

Background:  

Candida species are responsible for causing serious systemic infections among hospitalized patients. Although mortality rates in candiduria range from 18–30%, no study has thus far focused on identifying factors associated with this high mortality.

Objectives:  

To identify factors associated with mortality among hospitalized patients with candiduria at our centre.

Methods:  

We prospectively studied the microbiological and clinical characteristics of 77 consecutive cases of candiduria [>=10,000 colony forming units (cfu)/mL] hospitalized between Jan and Aug 2003 [eight months]. Odds ratios [OR] for suspected risk factors were calculated using the Mantel-Haenzel test. Analysis was performed using the SPSS version 10.0 software.

Results:  

Among 77 patients, 20 [26%] died during their hospital stay. Analysis showed the following factors to be significantly associated with mortality: use of urinary diversionary devices [OR 8.8; 95% confidence interval (CI) 1.1–70.5; p = 0.04]; use of two or more classes of antibiotics [OR 4.1; 95% CI 1.2–13.9; p = 0.02]; ICU admission [OR 3.3; 95% CI 1.1–9.3; p = 0.03]; and renal failure [OR 2.9; 95% CI 1.1–8.2; p = 0.05]. Besides, the following factors approached statistical significance: fungal colony counts >=100,000 cfu/mL [OR 4.5; 95% CI 0.9–21.4; p = 0.06]; acidosis (serum bicarbonate <=17 meq/L) [OR 3.6; 95% CI 0.9–13.7; p = 0.06]; positive urine nitrite test [OR 3.2; 95% CI 0.8–12.3; p = 0.09]; serum albumin <=3 g/L [OR 3.2; 95% CI 0.8–12.9; p = 0.10]; absence of any treatment interventions for candiduria [OR 2.9; 95% CI 0.9–9.0; p = 0.07]; age >= 65 years [OR 2.8; 95% CI 0.9–8.5; p = 0.07]; and treatment with antibiotics for >7 days prior to isolation [OR 2.5; 95% CI 0.9–7.1; p = 0.09]. Infection with non-albicans Candida and co-infection with bacterial urinary pathogens was not associated with increased mortality.

Conclusions:  

Factors associated with increased mortality in candiduria are those that might be expected to occur in critically ill patients. However, the associations with absence of treatment interventions and higher colony counts in urine culture indicate that fungal virulence characteristics may be important determinants of mortality. These factors might achieve statistical significance in larger case series of candiduria.