The incidence of fungal urinary tract infections, largely caused by Candida species, is rapidly increasing in hospitalized patients. In just one decade, the proportion of fungal urinary isolates from medical intensive care units has increased from 22% to 39%. The significance of isolated fungi from the urinary tract remains a subject of considerable debate. Nevertheless, many patients with funguria receive antifungal drugs, which is expensive and may be contribute to selection of drug resistant fungi. Since there is an urgent need to understand the significance of fungal urinary tract isolates, the applicant plans to perform a series of 5 patient-oriented research projects. Project 1 is a prospective observational study of >600 patients with funguria from 2 centers over 24 months. The patients will be followed longitudinally for persistence of infection and complications, and they will be compared to similar numbers of control patients without funguria (to be identified in Project 2, a hospital-based prospective surveillance project) to create models to address whether funguria is independently associated with mortality and whether funguria is associated with or predicts fungemia. The robust size of these models will allow the applicant to control for known risks of mortality and fungemia and to ask whether subpopulations (e.g., critically ill patients) are at higher risk for morbidity or mortality from fungemia. Project 3 will be to follow patients with funguria up to 1 year after hospital discharge to define long-term outcomes and complications. Project 4 will employ molecular typing methods to investigate strain relatedness between blood and urine fungal isolates in patients who have both funguria and fungemia. Project 5 will estimate the incidence of funguria among hospitalized patients and the impact of funguria on resource utilization nationwide using various health care databases. From the above studies, the applicant expects to generate information that will help clinicians employ focused strategies toward the patient with funguria and may result in cost savings while contributing to the effort to avoid a shift towards azole-resistant fungi.
