ABSTRACT
Objectives: Candida albicans is an opportunistic fungal pathogen which causes urinary tract candidiasis in humans. In this research, we tried to find out the frequency of the Urinary Tract Infections associated with Candida albicans in patients who referred to Central Laboratory of Dr. Shariati Hospital, during 2 years (April 2006- April 2008).
Materials and Methods: According to the archived recorded data, the questionnaires were filled out. At the end of this retrospective research, the statistical tests of Chi Square were operated through SPSS software version 15.
Outcomes: The results showed that, the Urinary Tract Infections associated with Candida albicans included 6.8% of patients. The remaining 93.2% of Urinary Tract Infections had related to bacterial pathogens.
Conclusions: The statistical analyses confirmed the significant association between Urinary Tract Infections caused by Candida albicans and female gender (P<0.05).
Keywords: Candida albicans, urinary tract infections, Candiduria
OBJECTIVES
Community-acquired Urinary Tract Infections (UTIs) are a frequent problem worldwide which are caused by microbial invasion to different tissues of the urinary tract (1,3). Fungi are a portion of microbial population that may contribute as fungal uropathogens in UTIs. In the last 2.5 decades the fungal UTIs due to Candida genus yeast has increased significantly (3,4).
The healthy urinary tract is sterile so, the presence of Candida yeasts in the urine implicates a variety of clinical situations (5-7). Candiduria can be demonstrated as symptomatic or asymptomatic UTIs; the incidence of lower urinary tract infections caused by yeasts is fourfold more common in women than in men (5). Furthermore, the results of different studies have indicated that UTIs in women are very common (7-12).
The predisposing factors of UTIs including gender, genetic predisposition, behavioral factors, urologic structural abnormalities, diabetes, immune-suppression, pregnancy, hypertension, stone formation, nosocomial acquired infections and instrumentation like catheterization (7,8,13,14).
The principal aim of the present survey, was to reveal the frequency of the Urinary Tract Infections associated with Candida albicans in patients who referred to Central Laboratory of Dr. Shariati Hospital, Tehran-IRAN, during 2 years (April 2006- April 2008). ❑
MATERIALS AND METHODS
In this 2-year surveillance, 4136 patients with or without clinical symptoms of UTIs who referred to the Central Laboratory of Dr. Shariati Hospital (April 2006- April 2008) were considered (7,8,15).
Through the archived documents at the Central Laboratory of hospital, the questionnaires (including pathogenic agent (Candida albicans), diagnostic techniques, gender, age, predisposing factors and if applicable, mortality) were filled out (7,8).
According to bioethical limitations, the names of patients were completely anonymous for the authors.
Eventually, the percentage of candiduria was calculated and by the help of SPSS version 15 (SPSS Inc., Chicago, IL, USA), the Chi Square (χ2) test was analyzed to prove the probable association between gender of patients and candiduria. The <0.05 was chosen for p value as the statistically significant. ❑
OUTCOMES
The results indicated that from 4136 (100%) patients who were involved, 1557 (37.6%) of patients were men and the remaining 2579 (62.4%) were women. The frequency of candiduria caused by Candida albicans was 283 (6.8%) from the total cases of 4136.
Moreover, 123 (43.5%) patients suffering from candiduria were men and the remaining 160 (56.5%) included women. So, the rest of patients who included 3853 (93.2%) persons were suffering from bacteriuria.
To be considered urinary yeast infection, the yeast was identified according to different characteristics such as their macroscopic, microscopic and physiological properties.
The samples were cultured on blood agar. After macroscopic and microscopic observation of yeast cells; for confirming the species of Candida albicans, the samples were transferred into human serum for 3 hours to grow the germ tubes. The observation of germ tubes in Candida yeast cells was the most important physiological property to report the yeast cells as Candida albicans.
The items including neither age of patients nor the risk factors for individuals were recorded; therefore, the missing items were excluded from this research (7,8). However, catheterization, surgical instrumentation and diabetes were reported for candiduria in men as the most important predisposing factors. In the recorded data, no mortality was reported. ❑
DISCUSSION AND CONCLUSIONS
The recent studies have shown that, because of prolonged hospitalization, immuno -compromised patients, uncontrolled use of antibiotics, prophylaxis by antifungal agents, catheterization, urinary tract surgeries and long period stays in intensive care units, the frequent of funguria and specially uropathogenic yeasts getting increased. The most important uropathogen causing candiduria is Candida albicans (3,16-19).
The results of studies indicate that, Candida albicans is the causative fungus for 50% to 70% of all candiduria isolates (3,16,20,21).
The results of different international studies have shown that Candida albicans is still the most common isolated species (3,22-24).
In our previous 1-year study, the prevalence of UTIs associated with Candida albicans included 5.9% of microbial UTIs (31.7% of candiduria were seen in men and 68.3% in women) (7) while in our present 2-year study, the incidence of UTIs associated with Candida albicans included 6.8% of microbial UTIs (43.5% of candiduria were seen in men and 56.5% in women). In addition the statistical examinations of χ2 revealed a significant association between female gender and UTIs caused by Candida albicans (p< 0.05). The authors of the present investigation believe that, these kinds of surveillances must be performed at regular intervals to follow any changes in the causative fungal uropathogens. ❑
References
- 1.Andrade SS, Sader HS, Jones RN, et al. Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: Time for local guidelines? Mem I Oswaldo Cruz. 2006;101:741–748. doi: 10.1590/s0074-02762006000700006. [DOI] [PubMed] [Google Scholar]
- 2.Obiogbolu CH, Okonko IO, Anyamere CO, et al. Incidence of Urinary Tract Infections (UTIs) among pregnant women in Akwa metropolis, Southeastern Nigeria. Sci Res Essays. 2009;4:820–824. [Google Scholar]
- 3.Da Silva EH, Da Silva Ruiz L, Matsumoto FE, et al. Candiduria in a public hospital of Sao Paulo (1999-2004): Characteristics of the yeast isolates. Rev Med Trop. 2007;49:349–353. doi: 10.1590/s0036-46652007000600003. [DOI] [PubMed] [Google Scholar]
- 4.Brito LR, Guimaraes T, Nucci M, et al. Clinical and microbiological aspects of candidemia due to Candida parapsilosis in Brazilian tertiary care hospitals. Med Mycol. 2006;44:261–266. doi: 10.1080/13693780500421476. [DOI] [PubMed] [Google Scholar]
- 5.Cantillep AO, Lecciones JA, Almario JS, et al. Positive Urine Cultures for Candida albicans in 55 patients at Makati Medical Center: Implications for management. J Microbiol Infect Dis. 1995;24:47–53. [Google Scholar]
- 6.Fisher JF, Chew WH, Shadony S, et al. Urinary tract infections due to Candida albicans. RID. 1982;4:1107–1118. doi: 10.1093/clinids/4.6.1107. [DOI] [PubMed] [Google Scholar]
- 7.Behzadi P, Behzadi E. The Microbial Agents of Urinary Tract Infections at Central Laboratory of Dr. Shariati Hospital, Tehran, Iran. Turk Klin Tip Bilim. 2008;28:445–449. [Google Scholar]
- 8.Behzadi P, Behzadi E, Yazdanbod H, et al. A survey on urinary tract infections associated with the three most common uropathogenic bacteria. Maedica. 2010;5:111–115. [PMC free article] [PubMed] [Google Scholar]
- 9.Howes DS. Urinary Tract Infection, Female. http://emedicine.medscape.com/article/778670-print J eMedicine. 2009 [Google Scholar]
- 10.Cunha BA. Urinary Tract Infection, Males. http://emedicine.medscape.com/article/231574-overview J eMedicine. 2009 [Google Scholar]
- 11.Kolawole AS, Kolawole OM, Kandaki-Olukemi YT, et al. Prevalence of urinary tract infections (UTI) among patients attending Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State, Nigeria. Sci Res Essays. 2009;1:163–167. [Google Scholar]
- 12.Cunha BA. Urinary Tract Infection, Females. http://emedicine.medscape.com/article/233101-overview J eMedicine. 2009 [Google Scholar]
- 13.Dulawa J. Urinary tract infection-2003. Ann Acad Med Bialostoc. 2004;49:182–184. [PubMed] [Google Scholar]
- 14.Hooton TM. Pathogenesis of urinary tract infections: an update. J Antimicrob Chemoth. 2000;46:1–7. [PubMed] [Google Scholar]
- 15.Ebie MY, Kandakai-Olukemi YT, Ayanbadejo J, et al. Urinary tract infections in a Nigerian Military Hospital. Nig J Microbiol. 2001;15:31–37. [Google Scholar]
- 16.Zarei Mahmoudabadi A, Keradmand AR, Enayatollahi N, et al. Frequency of Candiduria in Inpatients and Outpatients inDepartment of Urology, Golestan Hospital, Ahvaz, Iran. IJKD. 2009;3:114–115. [PubMed] [Google Scholar]
- 17.Binelli CA, Moretti ML, Assis RS, et al. Investigation of the possible association between nosocomial candiduria and candidaemia. Clin Microbiol Infect. 2006;12:538–543. doi: 10.1111/j.1469-0691.2006.01435.x. [DOI] [PubMed] [Google Scholar]
- 18.Lundstrom T, Sobel J. Nosocomial candiduria: a review. Clin Infect Dis. 2001;32:1602–1607. doi: 10.1086/320531. [DOI] [PubMed] [Google Scholar]
- 19.Abelson JA, Moore T, Bruckner D, et al. Frequency of fungemia in hospitalized pediatric inpatients over 11 years at a tertiary care institution. Pediatrics. 2005;116:61–67. doi: 10.1542/peds.2004-1605. [DOI] [PubMed] [Google Scholar]
- 20.Lagrotteria D, Rotstein C, Lee CH. Treatment of candiduria with micafungin: A case series. Can J Infect Dis Med Microbiol. 2007;18:149–150. doi: 10.1155/2007/768734. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Ochipinti DJ, Gubbins PO, Schreckenberger P, et al. Frequency pathogenicity and microbiologic outcome of non-Candida albicans candiduria. Europ J Clin Microbiol Infect Dis. 1994;13:459–467. doi: 10.1007/BF01974635. [DOI] [PubMed] [Google Scholar]
- 22.Nucci M. Candiduria in hospitalized patients: a review. Braz J Infect Dis. 2000;4:168–172. [PubMed] [Google Scholar]
- 23.Matsumoto FE, Gandra RF, Ruiz LS, et al. Yeasts isolated from blood and catheter in children from a public hospital of Sao Paulo, Brazil. Mycopathologia. 2002;154:63–69. doi: 10.1023/a:1015540224658. [DOI] [PubMed] [Google Scholar]
- 24.Kobayashi CCBA, Fernandes OFL, Miranda KC, et al. Candiduria in hospital patients: a study prospective. Mycopathologia. 2004;158:49–52. doi: 10.1023/b:myco.0000038436.51918.d9. [DOI] [PubMed] [Google Scholar]