Seyed Reza Aghili - Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Mahdi Abastabar - Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Ameneh Soleimani - Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Iman Haghani - Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
Soheil Azizi - Department of Laboratory Medicine, Faculty of Allied Medical Sciences, Mazandaran University of medical science, Sari, Iran

Background and Purpose: Heart failure is a leading cause of hospitalization, and asymptomatic candiduria is common in hospitalized patients with low morbidity. However, in most patients, it is resolved spontaneously on the removal of the catheter. Despite the publication of guidelines, there are still controversies over the diagnosis and management of candiduria. However, in hospitalized patients with heart failure, the decision to treat candiduria is especially important since the nosocomial infections are associated with an increase in morbidity, mortality, length of hospital stay, and healthcare costs. Some species of Candida, such as Candida glabrata, are increasingly resistant to the first-line and second-line antifungal medications. The present study aimed to investigate the incidence of asymptomatic Candida urinary tract infection due to C. glabrata and antifungal susceptibility of Candida isolates in hospitalized patients with heart failure. Materials and Methods: In total, ۳۰۵ hospitalized patients with heart failure were studied to identify asymptomatic nosocomial candiduria during ۲۰۱۶-۱۷ in one private hospital in the north of Iran. The Sabouraud’s dextrose agar culture plates with a colony count of >۱۰۴ colony-forming unit/ml of urine sample were considered as Candida urinary tract infection. Candida species were identified based on the morphology of CHROMagar Candida (manufactured by CHROMagar, France) and PCR-RFLP method with MspI restriction enzyme. Antifungal susceptibility testing of the isolates was performed using five mediations, including itraconazole, voriconazole, fluconazole, amphotericin B, and caspofungin by broth microdilution method according to CLSI M۲۷-S۴. Results: In this study, the rate of asymptomatic Candida urinary tract infection was ۱۸.۸%, which was more common in people above ۵۱ years old and females (۷۰%). In addition to the urinary and intravascular catheter, the occurrence of candiduria in hospitalized patients had significant relationships with a history of surgical intervention, diastolic heart failure, and use of systemic antibiotics (P>۰.۰۵). Among Candida spp., non-albicans Candida species was the most common infectious agent (۵۹.۷%). Moreover, C. glabrata (n=۲۷, ۴۰.۳%) (alone or with other species) and Candida albicans (n=۲۷, ۴۰.۳%) were the most common agents isolated in Candida urinary tract infection. Based on the results of the in vitro susceptibility test, the C. glabrata isolates were ۱۵%, ۵۹%, ۷۰%, ۷۴%, and ۸۵% susceptible to caspofungin, amphotericin B, itraconazole, voriconazole, and fluconazole, respectively. Conclusion: According to the findings, there was a high prevalence of asymptomatic Candida urinary tract infection in hospitalized patients with heart failure. Besides, it was suggested that there was a shift towards non-albicans Candida, especially C. glabrata, in these patients. Therefore, asymptomatic candiduria in hospitalized patients with heart failure should be considered significant. Furthermore, the identification of Candida species along with antifungal susceptibility is essential and helps the clinicians to select the appropriate antifungal agent for better management of such cases.

Candida glabrata, Heart failure, Hospitalized Patients, Nosocomial candiduria