Profil Dan Pola Kepekaan Yeast Penyebab Candiduria Pada Pasien Catheter-Associated Urinary Tract Infections (CAUTI) di Ruang Perawatan Intensif Rumah Sakit Dr. Sardjito Yogyakarta

Merlins Renatasia Waromi, Prof. dr. Tri Wibawa, Ph.D., Sp.MK.(K)..; dr. Abu Tholib Aman, M.Sc., Ph.D., Sp.MK.(K).

2025 | Tesis-Spesialis | Mikrobiologi Klinik

Pendahuluan: Infeksi saluran kemih terkait kateter (CAUTI) merupakan infeksi saluran kemih yang terjadi pada individu yang mengalami kateterisasi kandung kemih dalam 48 jam terakhir. CAUTI termasuk salah satu infeksi terkait layanan kesehatan (HCAIs) yang paling umum, bahkan mewakili hingga 40?ri seluruh HCAIs dan sering ditemukan pada pasien yang dirawat di unit perawatan intensif. CAUTI akibat candiduria menjadi topik yang semakin menarik untuk diteliti karena menunjukkan pola patogenesis, faktor risiko, dan tantangan klinis yang berbeda secara fundamental dibandingkan CAUTI bakteriuria. Candida spp. memiliki kemampuan unik dalam membentuk biofilm padat dan resisten, yang meningkatkan daya lekat pada kateter serta menurunkan efektivitas terapi antijamur konvensional. Identifikasi spesies Candida penting karena beberapa spesies Candida menunjukkan peningkatan resistensi terhadap agen antijamur yang umum digunakan. Penelitian ini dilakukan untuk mendeskripsikan data karakteristik umum, distribusi spesies Candida, dan profil kerentanan antijamurnya di antara pasien CAUTI.

Metode: Penelitian ini merupakan penelitian deskriptif observasional yang menggunakan metode potong lintang (cross-sectional) dengan pendekatan retrospektif berdasarkan data sekunder selama periode Januari hingga Juni 2023. Peneliti mencatat dan mengumpulkan data laboratorium serta karakteristik klinis pasien (yaitu pasien yang dirawat di ruang perawatan intensif, menggunakan kateter urin, dan memiliki hasil kultur urin positif) melalui rekam medis elektronik. Peneliti menganalisis korelasi antara profil laboratorium dan karakteristik klinis dengan luaran secara komparatif, dengan menggunakan analisis bivariat dan multivariat.

Hasil: Sebanyak 112 pasien yang memiliki hasil kultur urin teridentifikasi Candida spp. dengan angka kuman ? 10³ CFU/mL dimasukkan ke dalam analisis. Riwayat pembedahan, ruang perawatan, penurunan tingkat kesadaran, dan waktu keseluruhan menuju diagnosis (overall time to diagnose) menunjukkan hasil yang signifikan terhadap outcome berupa kematian. Variabel yang memiliki korelasi paling kuat terhadap outcome kematian dalam analisis multivariat adalah riwayat tindakan pembedahan dan penurunan tingkat kesadaran. Sebagian besar hasil kultur urin positif pada pasien CAUTI candiduria merupakan Candida non-albicans (N = 73; 65,17%), dibandingkan dengan Candida albicans (N = 39; 34,82%). Spesies Candida yang paling dominan adalah Candida tropicalis (35,71%), diikuti oleh Candida albicans (34,83%) dan Candida parapsilosis (10,71%). Pola kepekaan antijamur tertinggi ditemukan pada C. parapsilosis dan C. tropicalis dibandingkan dengan isolat Candida spp. lainnya dalam studi ini. C. parapsilosis menunjukkan sensitivitas 100% terhadap hampir seluruh antijamur yang diuji, kecuali terhadap Flucytosine (81,8%). C. tropicalis menunjukkan sensitivitas 100% terhadap Micafungin, Fluconazole, Flucytosine, Clotrimazole, Caspofungin, Echinocandin, dan Ketokonazole, serta sensitivitas 94%–97% terhadap Voriconazole dan Amphoterisin B. C. glabrata merupakan spesies yang paling resisten dalam studi ini, yaitu resisten terhadap Ketokonazole (100%), Caspofungin (77,7%), dan Voriconazole (40%), meskipun masih sensitif 100% terhadap Micafungin, Fluconazole, Flucytosine, Clotrimazole, Amphoterisin B, dan Echinocandin.

Kesimpulan: Penelitian ini dilakukan di rumah sakit rujukan tersier di Indonesia dan menunjukkan bahwa riwayat tindakan pembedahan serta penurunan tingkat kesadaran memiliki korelasi yang signifikan terhadap luaran berupa kematian pada pasien CAUTI candiduria. Hasil kultur urin menunjukkan dominasi Candida non-albicans, dengan profil kerentanan terbaik pada C. parapsilosis dan C. tropicalis, sedangkan C. glabrata mulai menunjukkan resistensi terhadap Ketokonazole, Caspofungin, dan Voriconazole. 

Introduction: Catheter-associated urinary tract infection (CAUTI) is a urinary tract infection that occurs in individuals who have undergone bladder catheterization within the previous 48 hours. CAUTI is one of the most common healthcare-associated infections (HCAIs), accounting for up to 40% of all HCAIs, and is frequently observed in patients admitted to intensive care units. CAUTI caused by candiduria has become an increasingly important topic of study because it presents fundamentally different pathogenic patterns, risk factors, and clinical challenges compared to bacterial CAUTI. Candida species possess a unique ability to form dense and resistant biofilms, enhancing their adhesion to catheters and reducing the effectiveness of conventional antifungal therapies. Species identification is essential, as certain Candida species exhibit increased resistance to commonly used antifungal agents. This study aims to describe the general characteristics, Candida species distribution, and antifungal susceptibility profiles among CAUTI patients.

Methods: This study is a descriptive observational study employing a cross-sectional design with a retrospective approach, based on secondary data collected from January to June 2023. The researchers recorded and compiled laboratory data and clinical characteristics of patients (i.e., those admitted to intensive care units, using urinary catheters, and having positive urine culture results) from electronic medical records. The correlation between laboratory profiles and clinical characteristics with outcomes was analyzed comparatively using bivariate and multivariate analyses.

Results: A total of 112 patients with urine cultures positive for Candida spp. showing colony counts ?10³ CFU/mL were included in the analysis. A history of surgery, ward type, decreased level of consciousness, and overall time to diagnosis were found to be significantly associated with mortality outcomes. In the multivariate analysis, the variables most strongly correlated with mortality were history of surgical procedures and decreased level of consciousness. Most positive urine cultures in CAUTI patients with candiduria were caused by non-albicans Candida species (N = 73; 65.17%), compared with Candida albicans (N = 39; 34.82%). The most predominant species was Candida tropicalis (35.71%), followed by Candida albicans (34.83%) and Candida parapsilosis (10.71%). The highest antifungal susceptibility patterns were observed in C. parapsilosis and C. tropicalis compared with other Candida spp. isolates in this study. C. parapsilosis showed 100% sensitivity to nearly all tested antifungal agents, except for flucytosine (81.8%). C. tropicalis demonstrated 100% sensitivity to micafungin, fluconazole, flucytosine, clotrimazole, caspofungin, echinocandin, and ketoconazole, with 94–97% sensitivity to voriconazole and amphotericin B. C. glabrata was the most resistant species in this study, exhibiting resistance to ketoconazole (100%), caspofungin (77.7%), and voriconazole (40%), although it remained 100% sensitive to micafungin, fluconazole, flucytosine, clotrimazole, amphotericin B, and echinocandin.

Conclusion: This study was conducted at a tertiary referral hospital in Indonesia and demonstrated that a history of surgical procedures and decreased level of consciousness were significantly correlated with mortality outcomes in CAUTI patients with candiduria. Urine culture results revealed a predominance of non-albicans Candida species, with the best antifungal susceptibility profiles observed in C. parapsilosis and C. tropicalis, while C. glabrata showed emerging resistance to ketoconazole, caspofungin, and voriconazole.

Kata Kunci : Candiduria, catheter-associated urinary, tract infections, antifungal, intensive care unit