Nosocomial Candiduria in Critically Ill Patients Admitted to Intensive Care Units in Menoufia University Hospitals, Egypt

Aims: Detect the incidence of urinary tract infection caused by candida species and to determine their antifungal susceptibility, biofilm formation and its minimal biofilm inhibitory concentration. In addition, detect the importance of multiplex nested polymerase chain reaction (PCR) in detection of candidemia in serum of patients with candidurea.

Methodology: Study was carried out by collecting urine samples from 200 patients admitted in the intensive care unit inMenoufia university hospitals and suspected to have hospital acquired urinary tract infection. Isolation, identification and antifungal susceptibility testing were done. Biofilm formation and Minimum biofilm inhibitory concentration testing were detected. Patients with positive candiduria were tested for the presence of candida in serum by multiplex nested PCR.

Results: Candida spp. were isolated from urine of 38(19%) patients, 78.9% of them were catheterized, C. albicans was isolated from 18(47.3%) samples as detected by Analytical profile index (API system). Antifungal susceptibility show that Flucytosmine, Amphotericin B, Voriconazole were more effective antifungal agents against Candida spp (100%, 84.2% and 84.2% respectively). A total of 26 (%68.4) out of 38 Candida species isolates produced biofilm. 72.2% of the tested C. albicans, were resistant to fluconazole and had MBIC > 640 μg/mL while only 27.8% were sensitive to fluconazole and had MBIC < 10 μg/mL. 26.3% out of 38 patients with candiduria had candidaemia as detected by multiplex nested CR.

Conclusion: Candida albicans is the most common Candida spp that show biofilm production. There is increased in the percentage of the resistance to fluconazole in candida isolates in this study. The incidence of candidemia among patients with candidurea was high in our study.