THE SIGNIFICANCE OF FUNGURIA IN HOSPITALIZED PATIENTS

描述（改编自申请人摘要）：真菌感染的发生率 泌尿道感染，主要是由念珠菌属引起的， 住院患者增加。 在短短十年内， 从医学重症监护病房分离的真菌尿分离物从 22%到39%。 泌尿道分离真菌的意义 一个有相当多争论的话题。 然而，许多真菌尿患者 接受抗真菌药物，这是昂贵的，可能有助于 耐药真菌的筛选。 由于迫切需要 了解泌尿道真菌分离株的重要性，申请人 计划开展一系列5个以患者为导向的研究项目。 项目1 是一项前瞻性观察性研究， 24个月以上的中心 将对患者进行纵向随访， 感染和并发症的持续性，他们将被比较， 无真菌尿的对照患者数量相似（将在 项目2，基于医院的前瞻性监测项目），以创建模型 为了解决真菌尿是否与死亡率独立相关， 真菌尿是否与真菌血症相关或预示真菌血症。 强大的规模， 这些模型将允许申请人控制已知的死亡风险 和真菌血症，并询问是否亚群（例如，重症患者） 真菌血症的发病率或死亡率风险较高。 项目3将 将随访真菌尿患者出院后1年， 确定长期结果和并发症。 项目4将采用分子 血液和尿液中菌株相关性的分型方法 同时患有真菌尿症和真菌血症的患者中的真菌分离物。 项目5 将估计住院患者中真菌尿的发病率， 真菌尿对全国资源利用影响 护理数据库 从上述研究中，申请人预计将产生 信息，这将有助于临床医生采用重点战略， 患者真菌尿，并可能导致成本节约，同时有助于 努力避免转向唑类耐药真菌。

DESCRIPTION (adapted from applicant's abstract): 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.