Management of candiduria in hospitalized patients: a single-center study on the implementation of IDSA guidelines and factors affecting clinical decisions.

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.

Rapid preparation of Candida genomic DNA: combined use of enzymatic digestion and thermal disruption.

Nucleic acid based molecular technologies are the most promising tools for the early diagnosis of Candida infection. A simple and effective DNA preparation method is of critical for standardizing and applying molecular diagnostics in clinic laboratories. The goal of this study was to develop a Candida DNA preparation method that was quick to do, easy to perform, and bio-safe. Snailase and lyticase were screened and combined in this work to enhance the lysis of Candida cells. The lysis solution composition and metal bath were optimized to boost amplification efficiency and biosafety. A duplex real-time PCR was established to evaluate the sensitivity and specificity of the preparation method. Using the supernatant from the rapid preparation method as templates, the duplex PCR sensitivities for five common Candida species were determined to be as low as 100 CFUs. When compared to conventional preparation methods, the samples prepared by our method showed higher PCR detection sensitivity. PCR identification and ITS sequencing were 100% consistent, which was better than biochemical identification. This study demonstrates a rapid method for Candida DNA preparation that has the potential to be used in clinical laboratories. Meanwhile, the practical application of the method for clinical samples needs to be proven in future investigations.