From the Guidelines
This patient likely has a urinary tract infection (UTI) caused by Candida albicans, and I recommend treating with fluconazole as the drug of choice. The patient's symptoms of dysuria and leukocyturia, along with a urine culture revealing candiduria with a colony-forming unit (CFU) count of 10,000-49,000 CFU of Candida albicans, suggest a true fungal UTI [ 1 ]. According to the 2016 clinical practice guideline for the management of candidiasis by the Infectious Diseases Society of America, fluconazole is the preferred treatment for Candida UTI due to its efficacy in achieving high concentrations in the urine and its susceptibility to Candida albicans [ 1 ]. Some key points to consider in the treatment of Candida UTI include:
- The ability of the antifungal agent to achieve adequate concentrations in the urine is crucial [ 1 ]
- Candida albicans is relatively easy to treat with fluconazole, which achieves high concentrations in the urine [ 1 ]
- Other antifungal agents, such as flucytosine and amphotericin B, may be considered in certain cases, but fluconazole is generally the first-line treatment [ 1 ] It is essential to note that the patient's symptoms and urine culture results should be monitored closely during treatment to ensure the infection is resolving, and further evaluation may be necessary if symptoms persist or recur [ 1 ].
From the Research
Diagnosis and Treatment
The patient's symptoms of dysuria and leukocyturia, along with the presence of Candida albicans in the urine, suggest a diagnosis of candidal urinary tract infection (UTI) 2, 3, 4, 5, 6. The CFU count of 10,000-49,000 CFU of Candida albicans is significant and indicates a possible infection.
Risk Factors and Clinical Features
The patient's age and sex are not specifically mentioned as risk factors in the provided studies, but the presence of Candida albicans in the urine is a significant finding. The clinical features of candidal UTIs can vary from asymptomatic colonization to symptomatic cystitis, pyelonephritis, or even severe sepsis with fungemia 5.
Treatment Options
For symptomatic candidal UTIs, fluconazole is the antifungal agent of choice, achieving high urine concentrations with the oral formulation 2, 3, 4. Amphotericin B deoxycholate is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2, 5. Other azole agents and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 3, 4.
Key Points to Consider
- The presence of Candida species in urine does not always warrant antifungal therapy, especially in asymptomatic patients 2, 3, 4.
- Removing predisposing factors, such as indwelling catheters and antibiotics, can clear candiduria in almost 50% of asymptomatic patients 4.
- The patient's underlying health status and clinical features should guide the management of candidal UTIs 5, 6.