Candiduria linked to later candidemia in retrospective ICU cohort

In a retrospective study of critically ill adults with candiduria, 59 of 296 eligible intensive care unit patients developed subsequent candidemia, an observed proportion of 19.9%. Candida was isolated from blood within 30 days after it was detected in urine, with a median interval of three days and an interquartile range of two to seven days. The findings identify clinical factors associated with later bloodstream isolation in this ICU cohort, but they do not establish candiduria as an independent predictor or source of infection.

Investigators reviewed records from 2,514 unique ICU admissions at a tertiary hospital between August 2024 and August 2025. Candiduria was defined as growth of at least 10,000 colony-forming units per milliliter in a urine culture. It was detected in 371 patients, or 14.8% of the unique admissions, and 296 met the study’s eligibility criteria. Subsequent candidemia was defined as isolation of Candida species from a blood culture within 30 days after candiduria. Patients were grouped according to whether they developed this outcome, and the researchers compared their demographic, clinical, laboratory, treatment and mortality data. They also evaluated the distribution of Candida species and the antifungal susceptibility of bloodstream isolates.

After adjustment in the analysis, documented renal failure was associated with subsequent candidemia with an odds ratio of 2.08, while mechanical ventilation had an odds ratio of 2.23. Each additional point on the Sequential Organ Failure Assessment score was associated with an odds ratio of 1.15, and each additional seven days from ICU admission to candiduria had an odds ratio of 1.29. These results show associations with greater illness severity and longer ICU exposure among patients who already had candiduria; they do not demonstrate that any of these factors caused candidemia.

The primary model combined available variables to distinguish patients who later developed candidemia and achieved an area under the receiver operating characteristic curve of 0.767. Urine erythrocyte count alone had limited discrimination, with an area under the curve of 0.608. The comparison indicates that the multi-variable model was more informative than this urine measurement in the analyzed cohort. It does not establish that the model is sufficiently validated for routine surveillance or individual clinical decisions, and the investigators characterized the results as hypothesis-generating pending external validation.

ICU mortality was 68.6% across the analyzed cohort and 84.7% among patients who developed subsequent candidemia. The study does not establish that candiduria or candidemia caused these deaths. Its retrospective design, single-hospital setting and one-year observation period constrain generalization, while restricting the analysis to patients with candiduria means the findings apply to that selected group rather than to all critically ill adults. The evidence also cannot determine whether urine Candida directly originated the later bloodstream infection. Taken together, the results show that renal failure, mechanical ventilation, higher SOFA scores and longer time between ICU admission and candiduria marked ICU patients with a higher observed likelihood of subsequent candidemia, while leaving the causal role and independent prognostic value of candiduria unresolved.

Subject of Research: Clinical factors associated with subsequent candidemia among adult ICU patients with candiduria

Article Title: Candiduria in intensive care unit: differentiating a benign finding from a warning signal for subsequent candidemia

Article References: Oz, E., Tasdogan, A. M., Ozturk, M., Erinmez, M., & Zer, Y. (2026). Candiduria in intensive care unit: differentiating a benign finding from a warning signal for subsequent candidemia. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14423-y

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14423-y

Keywords: candiduria, candidemia, intensive care, Candida, bloodstream infection, retrospective cohort, renal failure, mechanical ventilation, illness severity, intensive, care, unit