From the Guidelines
Asymptomatic funguria generally does not require treatment in most patients, including those with positive Susceptibility Pattern Testing (SPT). The recommended approach is observation without antifungal therapy, as these infections typically resolve spontaneously and rarely lead to complications. Treatment should be considered only in specific high-risk populations such as neutropenic patients, very low birth weight infants, and patients undergoing urologic procedures, as stated in the clinical practice guideline for the management of candidiasis: 2016 update by the infectious diseases society of america 1. When treatment is necessary, fluconazole is typically the first-line agent, administered at 200-400 mg daily for 7-14 days, with the dose adjusted for renal function, as recommended in the clinical practice guidelines for the management of candidiasis: 2009 update by the infectious diseases society of america 1. Alternatively, amphotericin B bladder irrigation (50 mg/L of sterile water) may be used for patients with fluconazole-resistant species or those who cannot tolerate oral therapy. The rationale for withholding treatment in most cases is that asymptomatic funguria represents colonization rather than true infection, and unnecessary antifungal therapy contributes to resistance development, exposes patients to potential drug toxicities, and increases healthcare costs without improving outcomes. Some key points to consider in the management of asymptomatic funguria include:
- Elimination of predisposing factors, such as indwelling bladder catheters, is recommended whenever feasible 1
- Treatment with antifungal agents is NOT recommended unless the patient belongs to a group at high risk for dissemination 1
- Addressing underlying factors such as removing indwelling catheters, controlling diabetes, and discontinuing unnecessary antibiotics is more important than antifungal therapy for managing asymptomatic funguria. It's also important to note that testing for antifungal susceptibility should be considered for those when there is treatment failure or prior exposure of antifungals, as recommended in the 2016 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan 1.
From the Research
Treatment of Asymptomatic Funguria
The treatment of asymptomatic funguria, particularly with Susceptibility Pattern Testing (SPT), is a complex issue.
- Asymptomatic funguria is a common condition, especially in hospitalized patients, and is often associated with the use of indwelling urinary catheters, antibacterial therapy, and other risk factors 2, 3.
- The majority of cases of asymptomatic funguria are caused by Candida species, with Candida albicans being the most common isolate 2, 3.
- Treatment is generally recommended only for symptomatic patients or those with underlying health conditions that increase the risk of fungemia 4, 3.
- Antifungal agents such as fluconazole and amphotericin B are commonly used to treat funguria, with fluconazole being a popular choice due to its convenience and efficacy 2, 3.
- However, the use of antifungal therapy in asymptomatic patients is not universally recommended, as it may not impact morbidity or mortality, and may even contribute to the development of antifungal resistance 5.
Role of Susceptibility Pattern Testing (SPT)
- SPT can help guide the selection of antifungal therapy, but its role in the treatment of asymptomatic funguria is not well established 6, 2.
- The use of SPT may be more important in patients with symptomatic funguria or those with underlying health conditions that increase the risk of fungemia 4, 3.
- Further studies are needed to determine the optimal approach to the treatment of asymptomatic funguria, including the use of SPT and antifungal therapy 6, 2, 5.
Key Considerations
- The presence of multiple risk factors for funguria or invasive fungal infection (IFI) may be a more important predictor of outcomes than the use of antifungal therapy 5.
- Asymptomatic funguria may be a "sickness indicator" similar to bacteriuria in the elderly, and treatment may not always be necessary 5.
- A thorough evaluation of the patient's underlying health status and risk factors is essential in determining the need for antifungal therapy 4, 3.