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Purpose Candida albicans is the major cause of fungal UTI in neonates and infants but nowadays non albicans Candida is also increasing and these are mostly multidrug resistant. So it's important to know the species of candidal UTI for the proper management. This study was undertaken to determine the Candida species distribution in UTI along with their susceptibility pattern and outcome in infants and neonates admitted in different wards and ICU of our hospital. We also assess the incidence rate of candiduria in ICUs. Method Urine samples were collected from infants and neonates presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a clinical suspicion of candiduria and infants at risk of invasive candidiasis were also included in the study. Identification of Candida sp. was done by Gram's staining, germ tube test, chlamydospore formation on corn meal agar, color appearance on CHROM agar and also confirmed by MALDI-TOF Assay. Antifungal susceptibility was performed by using broth microdilution method as per the CLSI M27-A3/M27-S4. Result Urine samples were received from 219 infants, and Candida was isolated from samples from 52 infants (isolation rate 23.75%), of which 30 were admitted in pediatric or neonatal ICU and 22 in the wards. The incidence rate of candiduria in ICU was 3.25%. Candida albicans was the most frequently isolated species from the samples of infants in the wards (13/22 i.e. 59%), while Candida tropicalis was most frequently isolated from samples of infants in the ICUs (13/30 i.e. 43.34%). Candida glabrata was the least commonly isolated species and was only encopuntered in the ICU. There was no discrepancy between the results of conventional methods of identification and MALDI-TOF. Antifungal susceptibility was performed for 18 randomly selected isolates. All were found to be susceptible to caspofungin, micafungin, itraconazole, voriconazole, fluconazole, amphotericin B. Conclusion High suspicion of candiduria is needed especially in ICU admitted infants and identification of candida at species level along with the susceptibility pattern is important for the better management of patients. Introduction Yeast related urinary tract infections are commonly seen in neonatal and pediatric ICUs (Intensive care unit) and particularly in premature infants. Disease can vary from asymptomatic candiduria to sepsis. UTI is an important cause for fever in infants and neonates [1]. Several case reports and studies showed that the candidal UTI has increased during the last few decades [[1], [2], [3], [4]]. Common risk factors for Candida infection includes prematurity, prolonged hospitalization, broad spectrum antibiotic therapy, use of catheter, total parenteral nutrition and renal and urinary tract malformations. Although C. albicans is the most frequently reported species in candidal urinary tract infection but non-albicans Candida species also increasing now as the causative agent of UTI as reported in many studies. C. tropicalis , C. glabrata , C. parapsilosis , C. lusitaniae , C. guilliermondii and C. krusei are non-albicans species that cause candiduria [5]. It is important to know Candida spp. for the proper management of UTI because many non-albicans Candida spp. are resistant to treatment with fluconazole [6]. The purpose of the present study was to determine the prevalence of Candiduria along with risk factor assessment in infants and also to determine common Candida species associated with UTI in infants along with their susceptibility pattern which will help the clinicians in the better management of candiduria. Incidence rate of candiduria in ICU's of our hospital was also assessed. Section snippets Material and methods This study was conducted in the department of Microbiology during April 2017 to December 2018 at All India Institute of Medical Sciences, New Delhi. Ethical clearance was obtained from institute ethics committee, AIIMS with reference no. IEC/NP-25/2014 RP-10/2014 OP-3/09.02.2017. Only infants and neonates were included in the study. Urine samples were collected from infants presented in pediatrics and neonatal ICU (intensive care units) and clinical wards with a high clinical suspicion of Results Out of the total 219 urine samples received from different wards and ICU, 52 infants showed growth of Candida spp. in urine, so the isolation rate of Candida species in our institute was found to be 23.75%. Out of these 52 candiduria cases 30 infants were from ICU and 22 were from wards. Direct microscopy of urine samples was positive for budding yeast cells in 46 infants. Isolation rate of Candida from infants admitted in ICU was 57.69% (n = 30) while from wards the isolation rate was 42.30% Discussion Urinary tract infection of a fungal etiology is one of the important factors for morbidity and mortality in hospitalized patients. Several studies showed that candidal UTI is an emerging problem in infants and neonates [4]. Candiduria is rare in healthy people but the frequency is relatively high in hospitalized patients [7]. The incidence rate of candiduria in ICU was found to be 3.25% in our institute. Isolation rate of candida species in infants in our study was found to be 23.75% which was Conclusion Hospital acquired candiduria in infants is increasing these days and infants are usually not present with the typical symptoms of UTI and create difficulties for the clinician to recognize and treat such cases. Candiduria may also lead to disseminated candidiasis especially in hospitalized infants and the end results can be fatal. High index of suspicion of candiduria is necessary for early diagnosis of fungal UTI and initiation of antifungal treatment, especially in critically ill infants CRediT author statement Dr Renu Kumari Yadav: Data curation, Writing- Original draft preparation. Dr Gagandeep Singh: Supervision. Dr KVP Sai Kiran: Writing- Reviewing and Editing. Miss. Azka Iram: Investigation. Mr Bhaskar Rana: Resources. Mrs Saumya CS: Investigation, Project administration. Dr Immaculata Xess: Conceptualization, Methodology. Declaration of competing interest None. References (22) N. Paul Factors associated with candiduria and related mortality J Infect (2007) C. Binelli Investigation of the possible association between nosocomial candiduria and candidaemia Clinical microbiology and infection (2006) P. Kooshki et al. The patterns of colonization and antifungal susceptibility of Candida, isolated from preterm neonates in Khorramabad, South West of Iran J Mycol Med (2018) M. Laverdiere Susceptibility patterns of Candida species recovered from Canadian intensive care units J Crit Care (2007) M. Vijayakumar Revised statement on management of urinary tract infections Indian Pediatr (2011) E.H.d. Silva Candiduria in a public hospital of São Paulo (1999-2004): characteristics of the yeast isolates Rev do Inst Med Trop São Paulo (2007) R. Saha Pattern of Candida isolates in hospitalized children Indian J Pediatr (2008) D. Lagrotteria et al. Treatment of candiduria with micafungin: a case series Can J Infect Dis Med Microbiol (2007) E.L. Berkow et al. Fluconazole resistance in Candida species: a current perspective Infect Drug Resist (2017) N. Jain Biofilm formation by and antifungal susceptibility of Candida isolates from urine Appl Environ Microbiol (2007) Z. Seifi Candiduria in children and susceptibility patterns of recovered Candida species to antifungal drugs in Ahvaz Journal of nephropathology (2013) Navigate Down View more references Cited by (0) Recommended articles (6) View full text © 2023 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved. About ScienceDirect Remote access Shopping cart Advertise Contact and support Terms and conditions Privacy policy We use cookies to help provide and enhance our service and tailor content and ads. By continuing you agree to the use of cookies . Copyright © 2023 Elsevier B.V. or its licensors or contributors. ScienceDirect® is a registered trademark of Elsevier B.V. ScienceDirect® is a registered trademark of Elsevier B.V.
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