Department of Clinical Laboratory, The 980th Hospital of PLA Joint Logistical Support Force (Bethune International Peace Hospital), 398 Zhongshan Road, Shijiazhuang, 050082, Hebei, People's Republic of China.
Eur J Clin Microbiol Infect Dis. 2021 Jan;40(1):59-65. doi: 10.1007/s10096-020-03999-1. Epub 2020 Jul 30.
Candiduria are common findings in clinic especially in hospitalized patients, while its significance remains undetermined. Since there are few criteria to follow, physicians tended to make decisions by personal experience in many cases in clinical practice. The present study was designed to unveil the present situation of candiduria management in hospitalized patients in clinical practice. A total of 251 hospitalized candiduria patients were retrospectively enrolled in the study. Clinical data on patient demographics, basic conditions, catheter using, urinary symptoms, laboratory data, and antifungal therapies were obtained from electronic medical records. The high rate of the candiduria cases were managed inappropriately after the introduction of the Infectious Diseases Association of America (IDSA) evidence-based recommendations, both in the management of urinary catheter and antifungal agents. Overtreatment was common in asymptomatic candiduria patients. For symptomatic patients, improper drug selections were not rare. In addition, a part of candiduria patients did not receive antifungal therapies although the IDSA recommends. A statistically significant difference was only found in hospital charges of symptomatic candiduria patients managed following IDSA or not. The recurrence rate, mortality, and hospital stay length were similar in candiduria patients regardless of the clinical management. Physicians tend to start empiric antifungal therapy for candiduria patients with pneumonia, multisite of Candida colonization, higher urine Candida CFUs, and long hospital stay. Candiduria has not received special attention today, and empirical antifungal treatment is common. IDSA guidelines are important to standardize the management of candiduria in clinic; however, the significance of the guidelines needs to be further clarified in future multicenter investigations.
尿培养白色念珠菌是临床上的常见发现，尤其是在住院患者中，但其意义尚未确定。由于缺乏明确的诊断标准，在临床实践中，医生在许多情况下往往依靠个人经验做出决策。本研究旨在揭示目前住院患者尿培养白色念珠菌管理的现状。共回顾性纳入 251 例住院尿培养白色念珠菌患者。从电子病历中获取患者人口统计学、基本情况、留置导尿管、尿路症状、实验室数据和抗真菌治疗等临床数据。在引入美国传染病学会（IDSA）基于证据的推荐意见后，尿培养白色念珠菌病例的治疗方法存在很多不规范，无论是留置导尿管的管理还是抗真菌药物的使用。无症状白色念珠菌尿患者中过度治疗很常见。对于有症状的患者，药物选择不当的情况并不少见。此外，尽管 IDSA 建议，但部分尿培养白色念珠菌患者未接受抗真菌治疗。只有在接受或不接受 IDSA 治疗的有症状白色念珠菌尿患者的住院费用方面存在统计学显著差异。无论临床管理如何，白色念珠菌尿患者的复发率、死亡率和住院时间均相似。医生往往会对患有肺炎、多部位念珠菌定植、更高的尿念珠菌 CFU 和住院时间较长的白色念珠菌尿患者进行经验性抗真菌治疗。目前，尿培养白色念珠菌并没有得到特别关注，经验性抗真菌治疗较为常见。IDSA 指南对于规范临床白色念珠菌尿的管理非常重要；然而，这些指南的意义需要在未来的多中心研究中进一步阐明。
