Unveiling the Spectrum of Nosocomial Candiduria: A Cross-Sectional Analysis in a Tertiary Care Hospital of Punjab, Pakistan

Abstract

Background: Bacteriuria and urinary tract infections (UTIs) top the list of prevalent nosocomial infections worldwide; Candida species have recently emerged as important pathogens in UTIs. Nosocomial candiduria refers to the identification of Candida in urine samples of hospital-admitted patients and has lately become prevalent, common among patients with protracted hospital stay, comorbidities, and invasive devices, including urinary catheters. Candida albicans has been found to cause candiduria most often in the past; however, new data show that NAC species are a rising trend. Candida tropicalis and Candida glabrata, as part of these NAC species are regarded with high risks for antifungal resistance, making their clinical assessment complex. This study aimed to discover the spectrum of Candida species causing nosocomial candiduria in a tertiary care hospital in Punjab, Pakistan, and to highlight the increasing trend of non-albicans Candida species.

Methods: This was a cross-sectional study in which 2,500 urine samples were collected from August 2023 to February 2024 from different wards of the Jinnah hospital and cultured on cysteine lactose electrolyte deficient (CLED) agar using standard microbiological techniques. Non-probability consecutive technique was used. The incubation period was 48-72 hours at 37°C. Candida species were identified based on colony morphology, Gram stain, Germ tube test, and sub-culturing on Chrom Candida Agar. Confirmation was done using an API Candida yeast identification panel (Biomerieux, France) by carbohydrate assimilation. Data was analyzed using SPSS 20.0. Categorical characters were summarized using frequencies of each category and the percentage that each category represented (e.g., distribution of Candida species, gender, and age groups). Crosstabulation and chi-square test were used to determine the relationship between nominal variables, including gender and Candida species. For nominal variables (e.g., gender), independent chi-square tests were used as the analysis since they test for differences in proportions. In this study, the level of significance for the test of hypotheses was set at 0.05.

Results: Out of 2,500 patients [1500 (60%) female, 1000 (40%) male], 17.96% (n=449) had Candida growth. Non-albicans Candida species were found to be more common at 69.2% (n=311), whereas Candida albicans was 30.73% (n=138). The most common species were C. tropicalis (41.2%) and C. glabrata (20%). Candiduria was more common in females and patients above 51 years of age.

Conclusion: The high prevalence of non-albicans Candida species in nosocomial candiduria cases emphasizes the need for species-level identification for effective antifungal therapy. With increasing resistance in non-albicans Candida species, early and accurate diagnosis is a must for optimal management. This study recommends targeted antifungal therapy and regular surveillance to combat the growing problem of candiduria in hospitals.