Community-acquired and hospital-acquired candiduria: comparison of prevalence and clinical characteristics.

Hospital-acquired candiduria (HAC) is a well-known finding, related to severely ill patients, prolonged antibiotic treatment, use of catheters, and invasive procedures. However, the risk factors and clinical significance of community-acquired candiduria (CAC) has not yet been described. In this study, the prevalence and clinical characteristics of CAC and HAC were compared. Demographic and clinical data from all patients with positive urinary cultures sent to the bacteriology laboratory of the Haemek Medical Center, Israel, between May 2005 and October 2006 which grew Candida spp. were collected and analyzed. A total of 100,522 urine samples were received, 19,611 (19.5%) of which grew uropathogens. Among them, 204 (125 community-acquired and 79 hospital-acquired) grew Candida spp. (1% of all positive and 0.2% of all samples). Patients with CAC were younger than those with HAC (mean 50.5 years vs. 68.3 years). Pregnant women and bed-ridden patients were more prevalent in CAC (22.5% vs. 1.9% and 46.8% vs. 18.55%, respectively). More patients with HAC suffered from renal failure (27.8% vs. 11.2%) and fever (62.0% vs. 25.6%), had urinary catheters (32.9% vs. 15.2%), and received antibiotic or immunosuppressive therapy in the last month (73.4% vs. 46.4% and 10.1% vs. 3.2%). Most candiduria cases were not treated medically and no further investigation was conducted. Significant differences between patients with CAC and HAC were found. Our results confirm that candiduria (nosocomial as community-acquired) infrequently requires intervention. However, the identification of high-risk patients is desirable and questions regarding the management of candiduria, both CAC and HAC, still remain unresolved.