THE SIGNIFICANCE OF FUNGURIA IN HOSPITALIZED PATIENTS

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。本研究的目的是了解医院真菌病的流行病学和住院真菌病患者的自然病史。本研究的具体目的是：1)确定具有播散性念珠菌病和死亡风险的真菌病患者亚群。我们将前瞻性地研究这种关联，控制重要的混杂因素，并确定真菌病是侵袭性真菌感染的重要预测因子的亚群。2)刻画真菌的长期自然历史。为了清楚地了解真菌病的潜在影响，需要描述从尿液中分离真菌的人的长期结果。我们将研究从尿液中初步分离真菌一年后的结果（注意：本课题将不在CSHS进行）。3)血液和尿液分离真菌的菌株亲缘关系测定。我们计划通过采用分子分型技术确定菌株相关性来明确回答这两个事件是否与污染性真菌病和真菌血症患者相关的问题。4)通过对尿液或血液中有无真菌的患者的血液和尿液标本进行抗生素测试，了解宿主对真菌的反应。如果有足够的技术发展，宿主对真菌反应的其他方面可以使用基因检测来进行。5)估计全国真菌病发病率及其对资源利用的影响。由于真菌病变得如此普遍，对这一问题的量化将指导这一领域未来的研究，并有助于计算未来干预措施的影响，例如努力减少真菌病并发症低风险患者的抗真菌药物使用。

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.