Emerging Microbiological Trends in Candiduria

this for granted. After Okinawa was returned to Japan in 1972, the program continued and so did the practice of Gram staining. Okinawa was a haven against managed care, extreme litigation, and the tendency to prescribe broad-spectrum antibiotics. Gram staining remained an integral part of clinical care. Currently, you can still see the white coats of house staff tainted with blue and red dots after long hours of Gram staining. Okinawa Chubu hospital could be called the " Galapagos of hospitals, " isolated, as it is, from pernicious forces of change. Unfortunately, Okinawa kept a distance not just from the United States but also from mainland Japan. Most of Japan's hospitals failed to be influenced by the exemplary practice near us. In Japan, the tendency to prescribe broad-spectrum antibiotics resulted in the explosion of antibiotic resistance. Japan also needs to learn from Okinawa Chubu Hospital, where good American practice is still vividly alive. References 1. Musher DM, Montoya R, Wanahita A. Diagnostic value of microscopic examination of Gram-stained sputum and sputum cultures in patients with bacteremic pneumococcal pneumonia. Sir—During the past 30 years, Candida in urine has evolved from a scientific curiosity described mainly in case reports to a common finding seen in 10% of hospitalized patients who have a pathogen recovered from urine [1]. The microbiology of candiduria differs from that of candidal infections at other sites in that, although Candida albicans remains the most common species found in cases of candiduria, non-albicans species of Candida constitute a higher proportion of isolates from other sites of candidal infection [2]. We undertook a study to identify the clinical and microbiological trends in candiduria at our 1900-bed tertiary-care center. Among 12,618 urine specimens cultured from January through August 2001 (a total of 8 months), only 21 specimens with 1100,000 cfu/mL of Candida species were seen. Of the 21 individuals who provided these specimens (age range, 2–70 years), 13 were female. Twenty of these patients were hospitalized at the time of fungal isolation, and 1 was treated as an outpatient. Concomitant factors included the following: presence of a self-retaining urethral catheter in 14 patients; bacterial infection at another site in 12; prior therapy with an antimicrobial for 10 (cepha-losporins for 8 patients, fluoroquinolones for 5, penicillins for 4, metronidazole for 4, and aminoglycosides for 2); renal failure (defined as a creatinine level of у1.5 mg/ dL) in 9; diabetes mellitus in 8; …