Treatment of Candida Lusitaniae Urinary Tract Infection
For Candida lusitaniae UTI, fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the recommended first-line treatment, as C. lusitaniae is generally susceptible to fluconazole. 1, 2
Treatment Algorithm Based on Clinical Presentation
For Symptomatic Candida lusitaniae UTI:
- Fluconazole 200 mg (3 mg/kg) daily for 2 weeks is the drug of choice due to its high urinary concentrations, oral formulation, and proven effectiveness 3, 1
- C. lusitaniae is generally susceptible to fluconazole and often resistant to amphotericin B, making fluconazole particularly appropriate for this species 2, 4
- Treatment should continue until symptoms have resolved and urine cultures no longer yield Candida species 5
For Pyelonephritis due to Candida lusitaniae:
- Increase fluconazole dosage to 200-400 mg (3-6 mg/kg) daily for 2 weeks 3, 5
- Consider imaging (ultrasound or CT) to rule out structural abnormalities, hydronephrosis, or fungus ball formation 3, 5
Management of Urinary Catheters and Obstruction
- Elimination of urinary tract obstruction is strongly recommended as a critical part of treatment 3
- For patients with nephrostomy tubes or stents, consider removal or replacement if feasible 3, 1
- Indwelling urinary catheters should be removed when possible, as they are major risk factors for candiduria and can lead to serious complications including candidemia 6, 4
Special Considerations
- Unlike some other non-albicans Candida species, C. lusitaniae is typically susceptible to fluconazole but may be resistant to amphotericin B 4, 2
- If fluconazole treatment fails or the patient has a fluconazole allergy, susceptibility testing should guide alternative therapy 6
- For disseminated infection originating from a urinary source, more aggressive treatment may be required 4
Common Pitfalls to Avoid
- Failing to distinguish between colonization and true infection - symptoms and risk factors should guide treatment decisions 5, 7
- Using echinocandins or other azoles (besides fluconazole) for lower urinary tract infections, as they have minimal excretion into urine and are generally ineffective for treating Candida UTI 3, 1
- Using lipid formulations of amphotericin B, which do not achieve adequate urine concentrations 3
- Overlooking the possibility of fungus balls, which may require surgical intervention in addition to antifungal therapy 3, 7
- Treating asymptomatic candiduria in patients without risk factors for dissemination 5, 7
Monitoring and Follow-up
- Monitor for clinical improvement and obtain follow-up urine cultures to confirm clearance of infection 5
- For persistent infection despite appropriate therapy, consider imaging to rule out anatomical abnormalities or fungus balls 3, 5
- If the patient develops signs of systemic infection, obtain blood cultures and consider broader antifungal coverage 4