A-263 Candiduria in Diabetic Patients: An Epidemiological Analysis in a Brazilian Population

Background Candiduria, defined as the presence of Candida in urine, can indicate asymptomatic colonization or an active urinary tract infection. In individuals with risk factors such as diabetes mellitus, this condition can lead to complications like fungal pyelonephritis and disseminated candidiasis. Chronic hyperglycemia weakens immune response, promotes fungal proliferation, and creates a favorable environment for Candida adhesion to the urothelium. This study analyzes the prevalence of Candida urinary tract infections in diabetic patients, evaluating its relationship with hyperglycemia and comparing findings with existing literature. Methods This is an epidemiological, cross-sectional study based on a laboratory database from a private lab in Fortaleza, Brazil. Urinalysis and fungal culture results from patients between January 2022 and February 2025 were evaluated. Parameters analyzed included leukocyturia and Candida colony counts (CFU/mL), along with species identification by Vitek 2 Compact and its association with diabetes. Results A total of 112,506 urine cultures were analyzed, of which 201 (0.18%) showed Candida growth. Among these, 43.7% (N=88) were diabetic patients, suggesting a significant prevalence of infection in this population. Among diabetics with Candida, 70% (N=62) were women. The most prevalent species was Candida glabrata, isolated in 43.3% (N=87) of the positive samples, with 60.9% (N=53) of these cases occurring in diabetics. Candida albicans was the second most common species, accounting for 29.3% (N=59) of the cases, but with a lower association with diabetes (30.5% (N=18) of cases). Candida tropicalis was identified in 12.9% (N=26) of the positive samples, with 38.5% (N=10) occurring in diabetics. The analysis of Candida colony counts at different CFU/mL concentrations revealed that 32% of diabetic patients presented fungal growth above 100,000 CFU/mL, whereas this high fungal load was observed in only 20% of non-diabetic patients. At intermediate concentrations (∼50,000 to ∼80,000 CFU/mL), there was no significant variation between the groups. Leukocyturia showed no significant difference between diabetic and non-diabetic patients infected with Candida. Only 12% of the diabetic population with Candida had positive leukocyturia, compared to 18% of non-diabetics, suggesting that the urinary inflammatory response may not be directly associated with the presence of the fungus. Conclusion The results indicate a strong association between diabetes and increased Candida presence in urine, with a higher prevalence among diabetic patients, particularly women. Candida glabrata was the most frequent species and strongly associated with diabetes, while Candida albicans showed lower prevalence. Fungal load was significantly higher in diabetics at concentrations above 100,000 CFU/mL, suggesting an impact of hyperglycemia on fungal proliferation. However, leukocyturia showed no significant differences, indicating that urinary inflammation may not be directly related to Candida infection in diabetics. These findings highlight the importance of microbiological surveillance in diabetic patients for early Candida detection, enabling proper clinical management and preventing complications. Reviewing existing literature is crucial to corroborate these findings and deepen understanding of the mechanisms linking diabetes and fungal urinary infections.