especially candida albicans consider as one of the most common cause of fungal infections leading to a range of life - threatening invasive to non - lifethreatening mucocutaneous diseases . according to nosocomial infection surveillance systems of the united state , candida spp . several reports over the last 30 years has been reported not only in dramatic increase in the prevalence of candiduria but also in the incidence of candida urinary tract infections ( uti ) . the recognition of differences in incidence , populations at greater risk , species distribution is important in order to establish appropriate measures of infection control and the management of this disease . the aim of our study was to determine epidemiology of candiduria in children in an iranian referral hospital . the diagnosis of a uti due to candida species is much more difficult and it has not been established the importance of quantitative urine cultures for uti due to candida . in our study , however , there is no consensus cut - off limit to define candiduria and investigators use different definitions , quantitation of the number of organisms in the urine to define infection was considered 10 yeast cfu / ml . each urine sample was cultured on chrom agar candida plates and incubated at 37c for 24 - 48h aerobically . the number of colonies on each plate were counted and recorded based on colony colors . candida isolates were identified based on colony morphology on chrom agar candida and germ tube production . the following data were collected from the medical records of patients : gender , age , hospital unit , duration of hospitalization , use of central venous and urinary catheters during the hospitalization , the use of antibiotics at time of diagnosis of candiduria , previous usage of antifungal drugs and clinical finding . the statistical package for the social sciences ( windows version 16.0 ; spss inc , chicago , us ) was used for all analyses . from may 2011 to february 2013 , among 4813 urine culture positive , 209 candida spp . isolates ( 4.3% ) i. candiduria was found in 66 girls ( 32% ) and 143 boys ( 68% ) . forty - one percent of reported infection was in patients between 1 month and 1 year , 24% in neonatant and 24% in patients 1 to 5 years ( tab . picu : pediatric intensive care unit , nicu : neonatal intensive care unit , cicu : cardiovascular intensive care unit . the highest frequency of cadiduria was seen in patients who had been hospitalized over a month ( 73 cases , 35% ) , between 2 weeks to 1 month ( 57 cases , 27% ) , between 5 day to 2 week ( 52 case , 25% ) followed by 27 cases ( 13% ) that were hospitalized less than 5 day . the highest frequency of cadiduria was seen in patients who received more than 2 antibiotics ( 37% ) or more than 3 antibiotics ( 24% ) during their hospitalization ( tab . the majority of children with candiduria were hospitalized in icus ( pediatric intensive care unit ( 24.5% ) , neonatal intensive care unit ( 12% ) , and coronary care unit ( 10% ) ( tab . i ) . among underlying diseases , the highest frequency belonged to cardiovascular disorder ( 18% ) , respiratory diseases ( 10% ) , anomaly of urinary tract ( 10% ) , uti or nephrogenic disease ( 10% ) , gastrointestinal and liver diseases ( 9% ) , infectious diseases ( 8.5% ) and neurologic disorders ( 8.5% ) ( tab . uti : urinary tract infections , rds : respiratory distress syndrome . among all patients , 38 ( 18% ) and 25 ( 12% ) had central catheter and urine catheter , respectively . diaper rash and oral thrush was reported in 70 ( 34% ) and 12 ( 6% ) of patients , respectively . in addition , 25 cases ( 12% ) had genital anomalies and candidemia was present in 5 cases ( 2% ) . thirty- four patients ( 16% ) were treated with systemic antifungal drugs . fluconazole was prescribed for 23 cases ( 11% ) , clotrimazol for 16 patients , nistatin for 12 cases and amphotericin b for 7 cases . four cases were treated with combination of fluconazole and amphotericin b and the others did not receive any treatment for their infection . in the present study , candiduria was diagnosed in 4.3% of the patients with uti . it has been reported that 11 to 52% of nosocomial urinary tract infections ( utis ) are caused by candida spp . [ 6 - 11 ] . increased age , female sex , antibiotic use , urinary drainage devices and prior surgical procedures are considered as risk factors for candiduria [ 12 , 13 ] . although females have higher risk for developing candiduria , in our study , similar to jain et al . report , candiduria was more common in males ( 68% ) than females ( 32% ) . candiduria has been dramatically increased among hospitalized patients especially among those patients with indwelling drainage devices [ 15 , 16 ] . in our study , long - term indwelling urethral catheters or other urinary drainage devices were present in 40% of patients and all of the patients with candiduria had a known underlying illness . a study performed by platt et al . showed that 26.5% of all urinary infections related to indwelling catheters were caused by fungi . were responsible for 25 of 60 ( 42% ) uti in infants admitted to a neonatal intensive care unit . the frequency of candidemia in our study was 2% that was less than philips et al . report which was reported that in the majority of patients the urinary tract was not the source of candidemia . it has been reported that the prevalence of candiduria in the icu population is increasing ranges from 19 to 44% of urine specimens depending upon different population and definition of candiduria [ 18 - 20 ] . candiduria and candidemia occur commonly in neonatal and pediatric icus and particularly in premature infants [ 12 , 17 , 21 - 25 ] . candida spp . were the pathogens identified in 42% of hospital - acquired urinary tract infections in a neonatal intensive care unit . in this study , the majority of children with candiduria were hospitalized in icus ( picu ( 24.5% ) , nicu ( 12% ) , cicu ( 10% ) . the higher number of candiduria cases in patients of icus might be due to concurrent factors that contribute to the selection of these pathogens such as underlying diseases , immunodeficiency , and multiple manipulations by health care personnel and altered bacterial flora as well as use of antibiotics and long hospital stay [ 18 , 19 ] . use of antibiotics consider as a chief risk factor to develop candida urinary tract infection . in our study , the highest frequency of cadiduria was seen in patients who had received more than 2 antibiotics and more than 3 antibiotics during their hospitalization ; although c. albicans is frequently reported as the most prevalent species infecting the urinary tract , non - albicans candida spp . which better adapted to the urinary tract environment accounted for more than 50% of urinary candida isolates [ 13 , 27 ] ; consequently , identification of candida spp . in addition , the strategic goals to optimize antimicrobial use including optimizing choice and duration of empiric therapy as well as monitoring and providing feedback regarding antibiotic resistance are recommended .
summarycandida spp . 
 especially candida albicans is considered as one of the most common cause of fungal infections . 
 the aim of our study was to determine epidemiology of candiduria in children who were referred to an iranian referral hospital . during may 2011 to february 2013 , among 4813 urine culture positive 
 , 209 candida spp . isolates ( 4.3% ) was found . 
 forty - one percent of cadiduria infection was seen in patients between 1 month and 1 year , 24% in neonatant and 24% in patients 1 to 5 years . 
 cadiduria was mainly found in patients who had received more than 2 or 3 antibiotic during their hospitalization ( 37% and 24% , respectively ) . in our study , the highest frequency of cadiduria 
 was seen in patients who had received more than 2 antibiotics and more than 3 antibiotics during their hospitalization ; therefore , the strategic goals to optimize antimicrobial use including optimizing choice and duration of empiric therapy as well as monitoring and providing feedback regarding antibiotic resistance are recommended .