What is the treatment for urosepsis caused by yeast?

Treatment of Urosepsis Caused by Yeast

For urosepsis caused by yeast, fluconazole 400 mg (6 mg/kg) daily is the recommended first-line treatment for patients with fluconazole-susceptible Candida species. 1

Initial Assessment and Diagnosis

• Obtain urine and blood cultures before initiating antifungal therapy
• Evaluate for urinary tract obstruction with imaging (ultrasound, CT)
• Assess for disseminated infection with dilated retinal examination within first week of therapy 1

Treatment Algorithm

First-line Treatment:

• Fluconazole-susceptible Candida species:
  • Fluconazole 400 mg (6 mg/kg) daily for at least 2 weeks 1, 2
  • Continue treatment until all signs and symptoms have resolved

Alternative Treatments:

• For fluconazole-resistant C. glabrata:

  • Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days OR
  • Oral flucytosine 25 mg/kg 4 times daily 1

• For severely ill patients or those with suspected disseminated infection:

  • Liposomal Amphotericin B 3-5 mg/kg daily with or without flucytosine 1
  • Consider step-down to fluconazole after clinical improvement

Source Control

• Eliminate predisposing factors (indwelling bladder catheters) whenever feasible 1
• For urinary tract obstruction, urgent decompression is required:
  • Nephrostomy tube placement or stent insertion
  • Removal of stones if present

Special Populations

Neutropenic Patients:

• Treat as for candidemia with an echinocandin (caspofungin 70-mg loading dose, then 50 mg daily; micafungin 100 mg daily; or anidulafungin 200-mg loading dose, then 100 mg daily) 1
• Duration: at least 2 weeks after first negative blood culture and resolution of neutropenia 1

Patients Undergoing Urologic Procedures:

• Oral fluconazole 400 mg (6 mg/kg) daily OR
• Amphotericin B deoxycholate 0.3-0.6 mg/kg daily for several days before and after the procedure 1

Duration of Therapy

• For uncomplicated candiduria with sepsis: minimum 2 weeks of therapy 1
• For pyelonephritis with sepsis: 2-4 weeks of therapy 1
• For disseminated candidiasis: continue until all signs, symptoms, and radiological abnormalities have resolved (typically 4-6 weeks) 1

Monitoring

• Daily assessment of vital signs and clinical status
• Follow-up urine cultures to document clearance
• Monitor renal function if using amphotericin B
• For persistent candiduria, evaluate for structural abnormalities or foreign bodies

Important Caveats

• Asymptomatic candiduria generally does not require treatment unless the patient is at high risk for dissemination (neutropenia, very low birth weight infants) 1
• Fluconazole achieves high urinary concentrations and is preferred over newer azoles and echinocandins, which do not achieve adequate urine concentrations 3
• Removal of urinary catheters alone may clear candiduria in up to 50% of cases 3
• For urinary fungus balls, surgical removal is strongly recommended with antifungal therapy 1

Urosepsis caused by yeast represents approximately 25% of all sepsis cases 4, 5 and requires prompt treatment to prevent complications. Early diagnosis, appropriate antifungal therapy, and control of any complicating factors in the urinary tract are essential for successful management.