Management of Candiduria Due to Indwelling Catheter
For a patient with candiduria due to an indwelling catheter, removal of the catheter is strongly recommended as the primary intervention, and antifungal therapy is not necessary unless the patient is symptomatic.
Assessment of Candiduria
- Candiduria is commonly encountered in hospitalized patients, particularly those with indwelling urinary catheters 1
- Asymptomatic candiduria typically represents colonization rather than infection and does not require antifungal treatment 1
- Determine if the patient has symptoms attributable to candiduria (dysuria, frequency, urgency, suprapubic pain) or is at high risk for candidemia 1
Primary Management
- Remove the indwelling bladder catheter if feasible, which is strongly recommended as the most effective intervention 1
- Catheter removal alone resolves candiduria in approximately 76% of cases without specific treatment 1
- In a well-designed trial, removal of the urinary catheter was the most promising intervention for clearing candiduria 1
- Catheter removal has been associated with decreased mortality in elderly patients with candiduria 2
When to Use Antifungal Therapy
- Antifungal therapy is NOT indicated for asymptomatic candiduria 1
- Antifungal therapy should be considered only in the following situations:
Antifungal Selection (if indicated for symptomatic infection)
- For fluconazole-susceptible organisms, oral fluconazole 200 mg (3 mg/kg) daily for 2 weeks is recommended 1
- 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 for 7-10 days 1
- For C. krusei, amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days 1
- Echinocandins do not achieve high urinary concentrations and are not recommended for urinary tract infections 1, 3
Common Pitfalls to Avoid
- Treating asymptomatic candiduria with antifungals, which can lead to the development of resistant flora 4
- Using subtherapeutic doses of fluconazole, which has been observed in clinical practice 2
- Failing to remove or replace the catheter, which is associated with higher mortality 2
- Using newer azole agents or echinocandins for urinary tract infections, as they fail to achieve adequate urine concentrations 5
Follow-up
- Consider follow-up urine cultures to confirm resolution if the patient was symptomatic 2
- If candiduria persists despite catheter removal and the patient remains symptomatic, reassess for possible upper tract involvement or other complications 1
Remember that the majority of candiduria cases in catheterized patients represent colonization rather than infection, and removal of the catheter is the most effective intervention that often eliminates the need for antifungal therapy 1.