From the Guidelines
Treatment for a male with Candida albicans in urine who has a urethral stent for kidney stones is generally recommended due to the high risk of dissemination and complications. The presence of the stent creates an environment where fungi can form biofilms, potentially leading to persistent infection or complications 1. According to the clinical practice guideline for the management of candidiasis, patients undergoing urologic procedures, such as those with a urethral stent, should be treated with oral fluconazole, 400 mg (6 mg/kg) daily, or AmB deoxycholate, 0.3–0.6 mg/kg daily, for several days before and after the procedure 1.
Key Considerations
- The stent should be removed or replaced if possible, as Candida can adhere to these devices, making eradication difficult while the stent remains in place 1.
- Patients should increase fluid intake to help flush the urinary system and follow up with urine cultures after treatment completion to ensure the infection has cleared.
- Treatment is important because fungal urinary tract infections in the presence of foreign bodies can lead to ascending infections, potentially causing pyelonephritis or systemic candidiasis, especially in immunocompromised patients.
Treatment Options
- Fluconazole is the drug of choice for treating Candida UTI, as it achieves high concentrations in the urine and is effective against Candida albicans 1.
- Alternative antifungals like voriconazole or echinocandins may be necessary for more resistant cases, although their effectiveness in treating Candida UTI is limited due to minimal excretion of active drug into the urine 1.
From the Research
Treatment of Candida Albicans in Urine with Urethral Stent
- The presence of Candida albicans in urine does not always require treatment, especially in asymptomatic patients 2.
- However, in patients with a urethral stent, such as those with kidney stones, the risk of complications from Candida albicans infection may be higher due to the potential for biofilm formation on the stent 3, 4.
- In cases where treatment is necessary, fluconazole is the recommended antifungal therapy, as it achieves high urinary levels and is effective against Candida albicans 4, 2.
- The management of candiduria on ureteral catheter is not consensual, but anti-fungal therapy should be initiated 48 hours to 3 weeks before the change of the stent to prevent recolonization of the stent 4.
- Regular change of the ureteral stent material every 3-6 months, depending on the patient's risk group, can help prevent infections 4.
- Patients with a urethral stent and Candida albicans in their urine should be closely monitored for symptoms of infection, such as pyelonephritis, prostatitis, or epididymo-orchitis, and treated promptly if symptoms develop 2.