Candida urinary tract infections, antifungal susceptibility and factors associated with candiduria among pregnant women seeking antenatal care at Murang’a County Referral Hospital, Kenya

BACKGROUND: Candida urinary tract infections (UTIs) are a growing public health challenge in clinical practice. Immunologic and physiological changes that occur in pregnancy make pregnant women more prone to UTIs. However, in resource-constrained settings like Kenya, where healthcare systems are underfunded and microbiology laboratories are inadequate, epidemiological data to inform infection prevention interventions for Candida UTI-associated complications in pregnancy are limited. In this study, we determined the prevalence of Candida UTI, the antifungal susceptibility of isolates, and factors associated with candiduria among pregnant women seeking antenatal care (ANC) at Murang'a County Referral Hospital, Kenya. METHODS: In this hospital-based cross-sectional study, 365 pregnant women were selected through systematic random sampling at Murang'a County Referral Hospital, Kenya, from May to October 2023. Demographic and clinical data were collected using a structured questionnaire. Clean-catch midstream urine samples were processed using standard techniques in the hospital's microbiology laboratory for culture, isolate identification, and antifungal susceptibility testing. RESULTS: The prevalence of candiduria among pregnant women attending ANC at Murang'a County Referral Hospital was 3.8% (95% confidence interval (CI): 2.1-6.4%; 14/365). The prevalence of Candida UTIs was 5.2% (95% CI: 1.9-8.5%; 9/174). Candida albicans was the predominant species identified in cases of candiduria (57.1%; 8/14) and UTI (55.6%; 5/9). A single isolate of C. albicans was resistant to amphotericin B, and two C. glabrata isolates were resistant to caspofungin. All other Candida species demonstrated sensitivity to fluconazole, voriconazole, caspofungin, micafungin, and flucytosine. HIV-positive women exhibited 16 times higher odds of candiduria compared to HIV-negative women (adjusted odds ratio = 15.6, 95% CI: 2.4-101.8, p = 0.004). CONCLUSION: Candida UTI was present among pregnant women in this study, with C. albicans as the predominant species. The Candida isolates exhibited high susceptibility to the antifungal agents tested. HIV-positive status was the sole predictor of candiduria. These findings highlight a need for integrated screening and management of candiduria in ANC for HIV-positive women and ongoing susceptibility surveillance to guide antifungal therapy.