Candiduria in intensive care unit: differentiating a benign finding from a warning signal for subsequent candidemia

Candiduria is frequently detected in hospitalized patients, particularly in intensive care units, where urinary catheterization, invasive procedures, and broad-spectrum antimicrobial exposure promote Candida colonization. Although often interpreted as colonization or contamination, its clinical significance remains uncertain in critically ill patients, in whom Candida colonization may signal increased risk for invasive infections. Therefore, identifying patients with candiduria who are at risk for subsequent candidemia remains clinically important. This retrospective study included intensive care unit (ICU) patients aged ≥ 18 years with candiduria at a tertiary hospital between August 2024 and August 2025. Candiduria was defined as Candida growth of ≥ 10,000 CFU/mL in urine culture and candidemia as isolation of Candida spp. from blood culture; candidemia occurring within 30 days after candiduria was classified as subsequent candidemia. Patients were grouped according to subsequent candidemia development. Demographic, clinical, laboratory, treatment, and mortality data were retrieved from hospital records. Species distribution and antifungal susceptibility of bloodstream isolates were assessed. Among 2,514 unique ICU admissions, 371 patients had candiduria (14.8%); 296 met the eligibility criteria and 59 developed subsequent candidemia (19.9%). The median interval from candiduria to candidemia was 3 days (IQR: 2–7). ICU mortality was 68.6% overall and 84.7% among patients with candidemia. Documented renal failure (OR: 2.08), mechanical ventilation (OR: 2.23), SOFA score (OR per point: 1.15), and time from ICU admission to candiduria (OR per 7 days: 1.29) remained associated with candidemia after adjustment. The primary model had an area under the curve (AUC) of 0.767 and urine erythrocyte count showed limited standalone discrimination (AUC: 0.608). Among ICU patients with candiduria, subsequent candidemia was associated with greater illness severity, longer ICU exposure, and higher ICU mortality. These findings identify factors associated with candidemia within a candiduric ICU cohort but do not establish candiduria itself as an independent predictor or source of bloodstream infection. They should be considered hypothesis-generating and require external validation before informing surveillance strategies.