High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: A matter of some concern?

Document Type : Original Articles


1 Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran

2 Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

3 Department of Laboratory Medicine, Faculty of Allied Medical Sciences, Mazandaran University of medical science, Sari, Iran


Introduction: Heart failure is a leading cause of hospitalization among different patients. Regarding the high resistance of Candida glabrata to antifungal agents, the isolation of this species in urine samples of patients with heart failure should be considered important problem due to difficulty in treatment.
Materials and methods: This study was investigated 305 hospitalized patients with Heart failure to identify asymptomatic candiduria during 2016 to 2017 in a Heart Center of Mazandaran University of Medical Sciences, at Sari, north of Iran. Candida isolates cultivated on SDA plates with colony count >104. Species identification was done based on morphology and PCR-RFLP method and finally antifungal susceptibility testing performed using 5 drugs included itraconazole, voriconazole fluconazole, amphotericin b and caspofungin.
Results: Intravascular catheter insertion (95%), diastolic heart failure (62.8%), history of surgery (62.0%), coronary artery bypass grafting (59.9%), diabetes mellitus (58.6%), use of broad spectrum anti-bacterial antibiotics (57.1%) and staying in hospital for seven days or more (44.3%) were major underlying conditions in these patients. In our study, asymptomatic candiduria rate was 18.8%, more common in 51< years age groups and women (70%) compared to men (30%). C. glabrata (n=27, 40.3%) and C. albicans (n=27, 40.3%) were the most common cause of candiduria in patients. Non-albicans Candida was found in 59.7% cases. There was significant relationship between history of surgical intervention, diastolic heart failure and use of systemic antibiotics and occurrence of candiduria in hospitalized patients (p> 0.05).
Conclusion: Cadiduria is an emerging problem in elder population especially in hospitalized patients with heart failure. Improved diagnosis methods such as culture on to chromogenic media and molecular detecting have now shown that non-albicans candida species are important pathogens. There is a definite risk of invasive candidiasis following candiduria in these patients at the presence of associated risk factors. C. glabrata and C. albicans were considered to be the most common yeast in heart failure patients with nosocomial candiduria. C. glabrata is now the second or third most frequently isolated Candida species from Candida urinary infections. Our study suggests the shifting trend towards non albicans candida especially C. glabrata compared to Candida albicans and this change causes some difficulties in treatment. Therefore asymptomatic candiduria in hospitalized heart failure patients should be considered, and the identification of candida species along with antifungal susceptibility is important and helps the clinician in selecting the appropriate antifungal agent for better management of such cases.