This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The incidence of fungal urinary tract infections, largely caused by Candida species, is rapidly increasing in hospitalized patients. In just a decade, the proportion of fungal urinary isolates from medical intensive care units has increased from 22% to 39%. The significance of fungi isolated from urinary tract remains a subject of considerable debate. We will perform a prospective study of hospitalized patients with funguria over a 12-month period. Patients with funguria will be followed longitudinally for persistence of infection and complications of funguria. We will also characterize similar-sized cohort of control patients known not to have funguria for comparison. These two populations will be used to create a large data set from which models can be developed to answer the questions of whether funguria is independently associated with fungemia, mortality, and morbidity associated with increased resource use. To comprehensively understand potential complications of funguria, we plan to follow long-term outcomes of patients with funguria up to 1 year after hospital discharge. We will use molecular-typing methods to investigate strain relatedness between blood and urine fungal isolates in patients who have both funguria and fungemia. This molecular typing will determine if fungi isolated from urine are associated with a serious systemic infection or represent a synchronous, unrelated lower tract process. From these comprehensive studies of funguria, we will develop focused strategies for the management of funguria that are intended to result in both cost savings and a reduction in the incidence of nosocomial infections caused by azole-resistant fungi.
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