The presence of Candida spp. in urine has traditionally been considered to be a colonization; however, in certain clinical circumstances, such as in critically ill patients, immunocompromised individuals, or those with chronic diseases, it gains greater relevance due to the possibility of active infection and complications. The aim of this study was to characterize the epidemiology (incidence, species distribution, demographic characteristics, and origin) of Candida spp. isolates in urine through a retrospective cross-sectional analysis of urine culture isolates from clinical samples between January 2016 and December 2023. Out of a total of 111,656 urine cultures, Candida spp. was isolated at 2.72% (n = 3037). The most frequently isolated species was Candida albicans (54.25%; 1646/3037), followed by Nakaseomyces glabrata (22.78%; 692/3037) and Candida tropicalis (10.2%; 311/3037). Advanced age (>70 years), male sex, presence of a urinary catheter, and origin from intensive care units, oncology, or surgical services were variables associated with a higher risk of candiduria, highlighting the relevance of candiduria in the presence of such clinical scenarios.

Background: Candiduria is a common finding in hospitalized patients, particularly in intensive care units (ICUs) and in those with indwelling urinary catheters. Additionally, Candida spp. is among the most frequent causes of healthcare-associated urinary tract infections and can lead to severe clinical manifestations in specific scenarios involving risk factors. Objective: The objective of this study is to describe and analyze the epidemiological features, clinical risk factors, therapeutic approaches, and clinical outcomes in a cohort of hospitalized patients with candiduria at a regional hospital. Methods: This was a retrospective, descriptive, cross-sectional study based on the selection of 207 urine cultures positive for Candida spp. between 1 February 2024, and 31 August 2024, at the Microbiology Laboratory of the Virgen de las Nieves University Hospital in Granada, Spain. Results: The most frequently isolated species was Nakaseomyces glabratus (42.03%), with no sex differences and a predominant occurrence in ICU patients (36.71%). Most patients had comorbidities (86.47%), urinary catheters (72.46%), and prior antibiotic use (75.85%). Less than half of the cases presented clinical symptoms (41.55%). Antifungal therapy was administered in 38.65% of cases, predominantly fluconazole (61/207; 29.47%), followed by echinocandins (12/207; 5.8%). Use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) was documented in 36.71% of patients. Conclusions: Candiduria is more frequently observed in elderly patients with multiple comorbidities, ICU admission, indwelling urinary catheters, prior antibiotic therapy, and SGLT2i use. Fewer than half of the episodes are symptomatic. Non-albicans yeast species, which often display distinct resistance patterns, are increasingly prevalent, with N. glabratus being the most frequently isolated.

Background: Metallo-β-lactamase (MBL)-producing Gram-negative bacteria represent one of the greatest therapeutic challenges in contemporary clinical microbiology because of their extensive antimicrobial resistance and the limited availability of effective treatment options. Aztreonam–avibactam and cefiderocol have emerged as promising therapeutic alternatives; however, comparative evidence from routine clinical practice remains limited. Methods: A systematic literature search was conducted in PubMed to identify studies published between 2015 and 2025 evaluating the in vitro activity of aztreonam–avibactam and cefiderocol against MBL-producing Gram-negative bacteria. A total of 22 fully accessible studies meeting the eligibility criteria were included and analyzed in the systematic review. In parallel, a retrospective cross-sectional study was performed including all urinary isolates producing MBL recovered at the Microbiology Laboratory of Virgen de las Nieves University Hospital (Granada, Spain) between January 2016 and December 2025. Antimicrobial susceptibility profiles for both novel agents and conventional antibiotics were analyzed. Results: Twenty-three studies met the inclusion criteria for the systematic review, of which 22 fully accessible articles were analyzed. In the systematic review, Enterobacterales accounted for 70.0% of the reported MBL isolates, with New Delhi metallo-β-lactamase (NDM) being the predominant enzyme globally (50.5%), followed by Verona integron-encoded metallo-β-lactamase (VIM) (39.4%). The crude aggregated in vitro susceptibility proportion across the literature was markedly higher for aztreonam–avibactam than for cefiderocol (93.1% vs. 58.1%). Conversely, in our local urinary cohort (n = 182), Enterobacterales were also the predominant pathogens (51.6%), but VIM was the most frequently detected carbapenemase (n = 107). In this local cohort, aztreonam–avibactam demonstrated 100% in vitro susceptibility against Enterobacterales (54/54) and exhibited a 77.8% wild-type (WT) phenotype against Pseudomonas spp. (35/45). Cefiderocol exhibited excellent activity against Pseudomonas spp. (86.2%, 50/58) but significantly lower susceptibility rates among Enterobacterales (39.6%, 21/53). Among conventional antimicrobials, in vitro susceptibility in Enterobacterales to gentamicin decreased significantly over time (from 62.5% to 32.8%; FDR-adjusted p = 0.029), whereas amikacin in vitro susceptibility significantly improved (from 60.0% to 88.1%; FDR-adjusted p = 0.048). Colistin maintained high susceptibility rates, ranging from 87.8% to 100% in Enterobacterales and 77.8% to 88.2% in Pseudomonas spp. Agents such as nitrofurantoin (restricted exclusively to Escherichia coli) and trimethoprim–sulfamethoxazole or fosfomycin were not evaluated for Pseudomonas spp., due to intrinsic resistance or absence of established EUCAST clinical breakpoints. Conclusions: Aztreonam–avibactam and cefiderocol exhibit promising but highly species-specific in vitro activity against MBL-producing Gram-negative bacteria. While colistin and amikacin remain active conventional in vitro alternatives, these laboratory findings represent potential microbiological potency rather than guaranteed clinical success. Prospective clinical trials and real-world outcome studies remain essential to evaluate the clinical efficacy, patient outcomes, and comparative in vivo effectiveness of these regimens in daily practice.