Symptomatic candiduria in neonates, infants, and pediatric patients admitted to ICUs: epidemiology, risk factors, clinical symptoms, and outcomes of empirical antifungal therapy.

Candiduria, defined as the presence of Candida spp. in urine, is more common among hospitalized patients, particularly those admitted to intensive care units (ICUs). This study aimed to determine the epidemiology, associated risk factors, clinical symptoms, ultrasound findings, and outcomes of empirical antifungal therapy in neonates, infants, and pediatric patients with symptomatic candiduria admitted to neonatal ICU (NICU) and pediatric ICU (PICU) in southern Iran. In this retrospective cross-sectional study, medical records of neonates, infants, and pediatric patients with candiduria admitted to the NICU and PICU of two tertiary-care hospitals in Shiraz, Iran, between March 2012 and March 2022 were reviewed. Data were extracted from the hospital information system. Among 19,900 ICU admissions (3,471 neonates; 4,810 infants; and 11,619 pediatric patients), 400 patients (2.01%) were diagnosed with candiduria. The prevalence was 2.18% (n = 76) in neonates, 1.58% (n = 76) in infants, and 2.13% (n = 248) in pediatric patients. Prematurity was the most common risk factor among neonates (29, 38.15%), whereas urinary catheterization was predominant in infants (41, 53.94%) and history of bacterial urinary tract infection in pediatric patients (165, 66.53%). Hydronephrosis (176, 44%) was the most frequent ultrasound finding. Most patients had an ICU stay of 1-5 days (335, 83.75%), and candiduria was typically diagnosed within the first three days of ICU admission. Fluconazole was the primary empirical antifungal agent, while amphotericin B was administered in selected cases. All patients achieved complete clinical and microbiological resolution following treatment. Our findings indicate that history of bacterial urinary tract infection, urinary catheterization, antibiotic exposure, poor feeding, and hydronephrosis are important predisposing factors for candiduria in critically ill neonates, infants, and pediatric patients. Fluconazole appears to be an effective first-line empirical therapy in this population.