THE SIGNIFICANCE OF FUNGURIA IN HOSPITALIZED PATIENTS

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。这项研究的目的是明确医院内真菌尿的流行病学和住院期间发生真菌尿的患者的自然病史。这项研究的具体目的是：1)确定有播散性念珠菌病和死亡风险的真菌性尿症患者的亚群。我们将前瞻性地调查这种关联，控制重要的混杂因素，并确定真菌尿是侵袭性真菌感染的重要预测因素的亚组。2)描述真菌尿的长期自然历史。为了清楚地了解真菌尿的潜在影响，需要描述从尿液中分离出真菌的人的长期结果。我们将研究最初从尿液中分离真菌一年后的结果(注：这一子项目不会在CSHS完成)。3)血、尿分离真菌菌株间亲缘关系的测定。我们计划通过使用分子分型技术来确定菌株的相关性，最终回答这两个事件是否与污染真菌尿症和真菌血症患者有关的问题。4)通过对尿液或血液中有真菌或无真菌的患者的血液和尿液标本进行抗菌素试验，了解宿主对真菌尿的反应。如果已经开发了足够的技术，宿主对真菌的反应的其他方面可以使用基因测试来执行5)估计全国真菌尿症的发病率和对资源利用的影响。由于真菌尿正变得如此普遍，对这一问题的量化将指导这一领域的未来研究，并将有助于计算未来干预措施的影响，例如努力减少真菌尿并发症风险较低的患者使用抗真菌药物。

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 objective of this study is to define the epidemiology of nosocomial funguria and natural history of patients that develop funguria while hospitalized. The specific aims of this study are: 1) Identification of subsets of patients with funguria at risk for disseminated candidiasis and death. We will prospectively investigate this association, control for important confounders, and identify subgroups in which funguria is a significant predictor of invasive fungal infection. 2) Delineation of the long-term natural history of funguria. To clearly understand the potential impacts of funguria, long-term outcomes of persons with fungi isolated from the urine need to be described. We will study outcomes up to one year after initial isolation of fungi from the urine (NOTE: this subjproject will not be done at CSHS). 3) Determination of strain relatedness between fungi isolated from blood and urine. We plan to definitively answer the question of whether the two events are related in persons with contaminant funguria and fungemia by employing molecular-typing techniques to determine strain relatedness. 4) Understand host response to funguria by perfoming anitbiody tests on blood and urine specimens from patients with and without fungi in their urine or blood. Additional aspects of host response against fungi may be performed using genetic testing, if sufficient technology has been developed 5) Estimation of the national incidence of funguria and impact on resoucrce utilization. Because funguria is becoming so common, quantification of this problem will guide future studies in this area and will help with calculations of impacts of future interventions, such as efforts to reduce antifungal utilization in patients at low risk for complications from funguria.