What is the significance of yeast in urinalysis?

From the Guidelines

The presence of yeast in urinalysis is a significant finding that requires evaluation in the context of the patient's clinical setting to determine its relevance and the need for antifungal therapy, as stated in the 2016 update by the Infectious Diseases Society of America 1. The significance of yeast in urinalysis can vary depending on the patient's symptoms, underlying medical conditions, and the presence of predisposing factors such as indwelling catheters or immunosuppression.

• In asymptomatic patients without predisposing conditions, observation may be warranted, as the presence of yeast may not necessarily indicate an infection 1.
• However, in patients with symptoms such as burning urination, frequency, and genital itching, or in those with underlying medical conditions such as diabetes or immunosuppression, antifungal therapy may be necessary.
• The choice of antifungal therapy depends on the severity of the infection, the presence of underlying medical conditions, and the susceptibility of the infecting organism to antifungal agents.
• Fluconazole is the drug of choice for treating Candida urinary tract infections (UTIs), as it achieves high concentrations in the urine and is effective against most Candida species, as shown in a randomized, double-blind, placebo-controlled trial 1.
• Other antifungal agents such as flucytosine and amphotericin B may be used in certain cases, such as in patients with fluconazole-resistant organisms or in those with severe infections.
• In addition to antifungal therapy, patients should be advised to practice good hygiene, increase fluid intake, and avoid irritants such as scented products to help prevent recurrent infections.
• Further evaluation may be necessary to identify underlying causes of recurrent infections, such as immunosuppression or anatomical abnormalities, as stated in the 2016 update by the Infectious Diseases Society of America 1.

From the Research

Significance of Yeast in Urinalysis

• Yeast in urinalysis can be an indicator of candiduria, which is a type of urinary tract infection caused by Candida species 2, 3, 4.
• The presence of yeast in urine can be verified by repeating the urinalysis and urine culture 2.
• Candiduria can be distinguished from bacteriuria using a predictive score, such as the NABY score, which takes into account factors like nitrite, antibiotic exposure, bacteria, and yeast in urine 3.
• Numerous yeast on urinalysis can predict candiduria with complete accuracy, and a scoring system can help identify patients with a low risk of bacteriuria 3.

Diagnosis and Management

• Symptoms of Candida urinary tract infections are similar to those of other pathogens, and diagnosis requires careful evaluation 2.
• Ultrasonography of the kidneys and collecting systems is the preferred initial study for symptomatic or critically ill patients with candiduria 2.
• Computed tomography (CT) can be used to discern pyelonephritis or perinephric abscess 2.
• The Sysmex UF-1000i urine analyzer can be used to detect candiduria, with a sensitivity of 61.7% and specificity of 84.1% 4.

Risk Factors and Complications

• Candiduria is common in hospitalized patients, particularly in the ICU setting, and is associated with factors like age, gender, and basic condition 4.
• Urinary catheterization is a risk factor for candiduria in ICU patients 4.
• Biofilm formation on urinary catheters can become a source of endogenous infection and affect catheter functionality and urinary stone formation 5.
• The most frequent yeast species isolated from urinary catheters are Candida albicans, Candida glabrata, and Candida tropicalis 5.