Frequency of candiduria in inpatients and outpatients in department of Urology, Golestan Hospital, Ahvaz, Iran.

SIR, Catheter-associated urinary tract infection is the most common nosocomial disease in catheterized patients. The first sign of this infection is symptomatic or asymptomatic bacteriuria or funguria. Funguria, fungal infection of the urinary tract, is increasing in incidence, mostly because of the increasing use of antibacterial agents and indwelling urinary catheters.1,2 Candiduria presents as an increasingly common nosocomial infection, which may involve all anatomic levels of the urinary tract, resulting in a spectrum of diseases varying from asymptomatic candiduria to clinical sepsis. Several authors believe that funguria can be a symptom of systemic candidiasis in critically ill patients.4 The disease is most commonly caused by Candida species but may also develop by other fungi.2 Candida albicans is the most common organism found in candiduria followed by C glabrata and C tropicalis.2,5 The aim of the present study was to determine the frequency of funguria and urinary tract infection in patients attending our department of urology at Golasten Hospital in Ahvaz, Iran. In addition, their etiological factors were addressed. We studied on 244 patients with urological problems presenting to the department of urology at Golestan Hospital. Over a 9-month period, a total of 244 urine samples from the patients (100 inpatients and 144 outpatients) were randomly collected. Uncentrifuged urine samples were used for colony count. Fifty microliter of each urine sample was cultured on Candida plates (CHROMAgar, Paris, France) and incubated at 37°C for 1 week, aerobically. Direct smear from urine sediment was also prepared and stained by Gram or methylene blue technique. Yeast cells, budding cells, and pseudohyphae were identifying features of positive smears. Candida species were identified based on colony morphology on Candida plates, germ tube production, and micromorphology on 1% Corn Meal Agar with Tween 80 (Hardy Diagnostics, Santa Maria, California, USA). The patients’ age range was between 5 and 78 years, and 51 (20.9%) of them were women. Urine cultures positive for Candida were yielded in 38 patients (15.6%), including 25 men (65.8%) and 13 women (34.2%). Whereas, in Pakshir and colleagues’ report on Foley catheterized patients, these rates were 21.3% for men and 35.1% for women. Candiduria is a common nosocomial infection afflicting the urinary tract. We found it in 15.6% of our patients, and Pakshir and colleagues1 reported a frequency of 28.7%, which are considerable rates. Candida albicans accounts for 50% to 70% of all Candiduria isolates, followed by C glabrata (20%) and C tropicalis.6 In our study, C albicans was identified in 25 patients (65.8%), followed by C glabrata in 8 (21.0%), C tropicalis in 3 (7.9%), C parapsilosis in 2 (5.3%), and C kruzei in 1 (2.6%). One isolate of Penicillium was also detected in urine cultures. Da Silva and colleagues7 also reported C albicans as the most frequent, followed by C tropicalis, C glabrata, and C parapsilosis. Urine cultures yielded more than 15 000 yeast colonies per milliliter in 13 cases (32.5%), followed by 5000 to 15000 colonies in 7 (25.0%), 1000 to 5000 colonies in 10 (25.0%), and less than 1000 colonies in 10 (17.5%). Zaini and coworkers8 believe that even one colony of Candida in urine culture in men is considerable and should be important for clinicians. The most common risk factors of candiduria are urinary indwelling catheters, antibiotics therapy, elderly, urogenital tract abnormalities, and diabetes mellitus.1-3,9 In our study, the conditions accompanied by candiduria were extended hospitalization in 21 patients (55.3%), benign prostatic hyperplasia in 12 (31.6%), Foley catheter insertion in 10 (26.3%), antibiotic therapy in 9 (23.6%), double-J stenting in 8 (21.0%), hypertension in 5 (13.2%), kidney hematoma and urethral stenosis in 3 (7.9%),