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

Purpose: To investigate the epidemiology of candiduria in critically-ill patients with solid/hematological malignancies and to assess its predictive factors and prognostic value.Methods: 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 (candi-duria (-)).Results: One-hundred-seventy-three patients were included. Solid cancer was the underlying oncological dis-ease 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 candi-demia 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. Candidu-ria 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).Conclusion: Candiduria is common in cancer critically-ill patients. We reported an increased rate of non-albi-cans species, over albicans species. Patients with candiduria had higher ICU mortality, probably related to higher frailty and clinical severity.(c) 2022 SFMM. Published by Elsevier Masson SAS. All rights reserved.

Automated summary

This study investigated the epidemiology of candiduria in critically-ill patients with solid/hematological malignancies and assessed its predictive factors and prognostic value. The results showed that candiduria is common in cancer critically-ill patients, with an increased rate of non-albicans species. Previous exposure to quinolones, mechanical ventilation, and renal replacement therapy were identified as independent factors predicting candiduria. Candiduria was associated with higher ICU mortality.