Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure

Amir Arastehfar; Sara Khanjari; Zahra Zareshahrabadi; Wenjie Fang; Weihua Pan; Elham Asadpour; Farnaz Daneshnia; Macit Ilkit; Teun Boekhout; David S Perlin; Farid Zand; Kamiar Zomorodian

doi:10.1093/mmy/myaa092

Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure

Amir Arastehfar, Sara Khanjari, Zahra Zareshahrabadi, Wenjie Fang, Weihua Pan, Elham Asadpour, Farnaz Daneshnia, Macit Ilkit, Teun Boekhout, David S Perlin, Farid Zand, Kamiar Zomorodian

Research output: Contribution to journal/periodical › Article › Scientific › peer-review

6 Citations (Scopus)

Abstract

Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.

LAY SUMMARY: Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.

Original language	English
Journal	Medical Mycology
DOIs	https://doi.org/10.1093/mmy/myaa092
Publication status	Published - 10 Dec 2020

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10.1093/mmy/myaa092

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Arastehfar, A., Khanjari, S., Zareshahrabadi, Z., Fang, W., Pan, W., Asadpour, E., Daneshnia, F., Ilkit, M., Boekhout, T., Perlin, D. S., Zand, F., & Zomorodian, K. (2020). Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure. Medical Mycology. https://doi.org/10.1093/mmy/myaa092

@article{d1c79693bc954ac09326477859c6b660,

title = "Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure",

abstract = "Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.LAY SUMMARY: Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.",

author = "Amir Arastehfar and Sara Khanjari and Zahra Zareshahrabadi and Wenjie Fang and Weihua Pan and Elham Asadpour and Farnaz Daneshnia and Macit Ilkit and Teun Boekhout and Perlin, {David S} and Farid Zand and Kamiar Zomorodian",

note = "{\textcopyright} The Author(s) 2020. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.",

year = "2020",

month = dec,

day = "10",

doi = "10.1093/mmy/myaa092",

language = "English",

journal = "Medical Mycology",

issn = "1369-3786",

publisher = "Informa Healthcare",

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Arastehfar, A, Khanjari, S, Zareshahrabadi, Z, Fang, W, Pan, W, Asadpour, E, Daneshnia, F, Ilkit, M, Boekhout, T, Perlin, DS, Zand, F & Zomorodian, K 2020, 'Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure', Medical Mycology. https://doi.org/10.1093/mmy/myaa092

Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure. / Arastehfar, Amir; Khanjari, Sara; Zareshahrabadi, Zahra et al.
In: Medical Mycology, 10.12.2020.

Research output: Contribution to journal/periodical › Article › Scientific › peer-review

TY - JOUR

T1 - Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018)

T2 - deviations from international guidelines and fluconazole therapeutic failure

AU - Arastehfar, Amir

AU - Khanjari, Sara

AU - Zareshahrabadi, Zahra

AU - Fang, Wenjie

AU - Pan, Weihua

AU - Asadpour, Elham

AU - Daneshnia, Farnaz

AU - Ilkit, Macit

AU - Boekhout, Teun

AU - Perlin, David S

AU - Zand, Farid

AU - Zomorodian, Kamiar

N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.

PY - 2020/12/10

Y1 - 2020/12/10

N2 - Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.LAY SUMMARY: Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.

AB - Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016-2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria.LAY SUMMARY: Candiduria is an underestimated clinical presentation among critically ill patients and detailed data are scarce in this regard. Given the high rate of fluconazole therapeutic failure and development of candidemia in some cases, the mistreatment of candiduria should not be overlooked by clinicians.

U2 - 10.1093/mmy/myaa092

DO - 10.1093/mmy/myaa092

M3 - Article

C2 - 33305331

SN - 1369-3786

JO - Medical Mycology

JF - Medical Mycology

ER -

Clinical and microbiological features of candiduria in critically ill adult patients in Shiraz, Iran (2016-2018): deviations from international guidelines and fluconazole therapeutic failure

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