Objective: To determine the prevalence and clinical features of Candida species in hospital-acquired urinary tract infections(HAUTI) in a neonatal intensive care unit (NICU).

Design: A retrospective study was conducted of HAUTI occurring in infants admitted to a NICU between January 1, 1989 and June 30, 1995. Hospital-acquired infection was defined as one occurring in an infant who was at least 7 days of age and who was hospitalized since birth. Urinary tract infection (UTI) was defined by a urine culture yielding a single organism with >1,000 colony forming units (CFU) from suprapubic aspiration or >10,000 CFU via urethral catheterization.

Results: Fifty-seven infants had 60 HAUTI over the study period. Candida species were responsible for 25 of 60 (42%) of HAUTI. The three most common pathogens were Candida albicans, Enterobacter cloacae, and Candida parapsilosis. At diagnosis of HAUTI, renal ultrasound studies showed abnormalities in 18 infants (32%) including renal fungus balls in 7, kidney stones in 4, nephrocalcinosis in 4, ureterocele in 2, and a polycystic kidney in 1. The median gestational age of infants with Candidal HAUTI was 26 wk (range: 23-37), which was significantly less than for infants with bacterial HAUTI, 28 wk (range: 23-40), (P=.04). Candidemia was present in 12 of 25 (48%) candidal HAUTI, significantly more often than bacteremia with bacterial HAUTI, 3 of 35 (8%), OR = 9.8 (95% CI: 2.4 - 40.7). The median age of infection for Candidal HAUTI was 34 days (range: 9 - 228), which was significantly earlier than for bacterial HAUTI, 79 days (range: 7 - 247),(P=.003).

Conclusions: 1) Candida species were the pathogens identified in 42% of hospital-acquired urinary tract infections in a NICU; 2) Candidemia was associated with 48% of candidal HAUTI and bacteremia with 8% of bacterial HAUTI; and, 3) Candidal HAUTI occurred significantly earlier than bacterial HAUTI.