Trends in the incidence and diversity of fungi recovered from urine

The diversity and incidence of fungal organisms recovered from the urine of patients at a tertiary level medical center was examined and compared over time. Mycologic culture records were examined for the 12 months prior to, and following the introduction of fluconazole to the hospital formulary in December 1991. 290 patients with 588 urine cultures from which fungi were recovered provided the database for this study. Candida albicans was the most common organism recovered in these cultures, followed by C. tropicalis. Torulopsis glabrata and C. parapsilosis. C. albicans was recovered alone in the urine of 54.4% of patients with funguria in the initial period and in 49.3% during the second. Funguria with T. glabrata nearly doubled (8.7% versus 17.1%) between these intervals (p < 0.05). Fungal urine cultures in the second period were also noted more frequently to grow multiple organisms (mixed cultures), and to show a greater diversity of species. Review of the prescribing of antifungal agents to these patient groups revealed no clear pattern of prior drug exposure influencing this change. Although introduction of fluconazole at this institution was associated with a trend toward the recovery of a higher frequency of fungi in the urine which are not C. albicans, no direct evidence to implicate the introduction of this important new antifungal as the cause of this phenomenon was found.