Korean J Urol.  2011 Sep;52(9):626-631.

Fungal Urinary Tract Infection in Burn Patients with Long-Term Foley Catheterization

• Kim J
• Kim DS
• Lee YS
• Choi NG

Abstract

PURPOSE
It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters.
MATERIALS AND METHODS
A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient.
RESULTS
Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI.
CONCLUSIONS
Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.

Keyword

Burns; Fungi; Urinary catheterization; Urinary tract infections

MeSH Terms

Anti-Bacterial Agents
Body Surface Area
Burns
Candida tropicalis
Catheters
Fungi
Humans
Logistic Models
Urinalysis
Urinary Catheterization
Urinary Catheters
Urinary Tract
Urinary Tract Infections
Anti-Bacterial Agents

Figure

• 

  FIG. 1 Time intervals from catheterization to fungal urinary tract infection (UTI) in burn patients. Three (3.2%) of 93 patients had fungal UTI during the 1st week of urethral Foley catheterization. Twenty-two (23.7%) of 93 patients had fungal UTI in the 2nd week, 27 patients (29.0%) in the 3rd week, 17 patients (18.3%) in the 4th week, 7 patients (7.5%) in the 5th week, and 17 patients (18.3%) at greater than the 6th week of urethral catheterization. Fungal UTI began to appear during the first week of urinary catheter indwelling.

• 

  FIG. 2 Time intervals from catheterization to fungal urinary tract infection (UTI) in burn patients according to TBSAB. Each axis stands for the interval from catheterization to fungal UTI on the basis of the number of patients. Three different lines of three shapes of hexagons stand for 3 groups by the percentage of burn: <30%, 30% to 44%, and ≥45% on the basis of total body surface area burned (TBSAB). For example, the axis of the 1st week means that none of the 36 patients with TBSAB <30%, only 1 (2.8%) of 35 patients with TBSAB in the range of 30% to 44%, and 2 (9.0%) of 22 patients with TBSAB ≥45% developed fungal UTI within the 1st week. As indicated in the figure, the peak incidence of fungal UTI occurred during the 4th week of Foley catheterization in the <30% TBSAB group, at the 2nd to 3rd week in the 30% to 44% TBSAB group, and at the 3rd week in the ≥45% TBSAB group. The intervals of catheterization to fungal UTI were related to TBSAB (Fisher's exact test, p=0.005).

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