Candiduria in patients with uretral catheter admitted in intensive care unit. Etiology and in vitro susceptibility to fluconazole

Background: The isolation of Candida species in urine in patients admitted in intensive care units who bear a vesical catheter is considered as a sign of bad prognosis. The etiological mechanisms and the appropriateness of administering an antifungal treatment in these patients is controversial. Patients and method: The prevalence of Candida species in urine and the in vitro susceptibility to fluconazole by means of the E-test were determined in 560 patients admitted in an intensive care unit. Results: In 60 patients (11%) Candida species was isolated in urine after catheter replacement. 56.7% of isolates corresponded to C. albicans, 21.7% to C. glabrata, 15% to C. tropicalis, 5% to C, parapsilosis and 1.7% to C. kefyr. Only two isolates (C. albicans and C. glabrata) had a minimal inhibitory concentration (MIC) ≥ 64 μg/ml (which was regarded as resistant) and 91% of strains had a MIC between 0.125 and 8 μg/ml. MIC 90% for C. albicans and C. tropicalis was 1 μg/ml, while it was 10 μg/ml for C. glabrata. Conclusions: C. albicans is the most frequent species isolated in urine in these patients. However, over 40% of cases are found to have non-albicans species, especially C. glabrata and C. tropicalis. The majority of Candida isolates (91%) are sensitive in vitro to fluconazole.