Excluding Funguria from CAUTI or “How to effortlessly reduce HAI-rates”

Schermafbeelding 2015-05-09 om 10.05.27

According to Dicks et al. (ICHE 2015;36:467-9) the presence of fungi in urine rarely represents true infection. The authors state, that excluding yeast from catheter-associated UTI surveillance definition reduced CAUTI-rates by 25% in community hospitals and at tertiary-care medical center.

While I agree, that in many instances candiduria represents colonization or contamination of the specimen and not invasive candidiasis, and that not all cases of candiduria need treatment, they all warrant a clinical evaluation. In my Iowa years (1992/93) Dick Wenzel, Mike Pfaller and other established the importance of yeast in HAI’s, Pittet and others developed indices to better detect patients with candidemia, and my own research showed that candida in urine was one of the most important warning signs in patients suspected for candidemia. Once excluded from surveillance definitions, will our colleagues still see the importance of this occurrence? True, fungi in urine not always represents true infection, but frequently are a warning sign.  I am not sure about the need to change CAUTI definitions, or why one would stop at fungi for exclusion, but in general believe that we should leave our definitions as stable as possible.