Incidence of candiduria and its outcomes in ICU patients- a single centre, prospective, observational study

·         Candiduria  is commonly encountered especially in ICU patients.

·         The patients who are susceptible for candiduria are the elderly, females, diabetic patients with indwelling urinary devices, those on antibiotics and those who have had prior surgical procedures.

·         The decision to treat or not treat candiduria is important since it may indicate an innocuous colonization in some cases whereas in others it may also be a marker of urinary tract infection.

·         Also,candiduria is a well-established risk factor for invasive candidiasis which in turn is associated with significant morbidity, mortality and cost in ICU patients.

·         Acute kidney injury (AKI) in the context of candiduria is primarily driven by direct fungal invasion and obstruction, with additional contributions from inflammation and immune dysregulation.

·         Candida can ascend from the lower urinary tract or seed the kidneys via hematogenous spread (candidemia). The kidneys are particularly susceptible due to their blood flow and filtration function, which allows for deposition and proliferation of fungal elements within renal tissue. Hence, AKI in candiduria is multifactorial, involving direct fungal invasion, obstruction from fungal balls or necrotic tissue, and dysregulated inflammation leading to tubular and papillary damage.Thus, early recognition and intervention are crucial to prevent irreversible renal injury and renal replacement therapy.Current guidelines only recommend the elimination of predisposing factors, such as indwelling bladder catheters ,whenever feasible for asymptomatic candiduria.Treatment with antifungal agents is not recommended unless the patient belongs to a group at high risk for dissemination such as neutropenic patients and very low-birth-weight infants.Since there are few guidelines to follow, physicians tend to make decisions by personal experience in many cases in clinical practice and presently there are very few studies that have been conducted in ICU to study the effect of candiduria on AKI and need for renal replacement therapy.

·         Hence, it becomes necessary to study regarding the incidence of candiduria in ICU patients and its outcomes in terms of incidence of acute kidney injury, need for renal replacement therapy, length of ICU stay and hospital mortality.