Management of Indwelling Catheters for Controlling Candiduria
For patients with candiduria and an indwelling catheter, removal of the catheter is strongly recommended as the primary intervention rather than routine catheter changes at fixed intervals.1
Understanding Candiduria with Indwelling Catheters
- Candiduria most commonly affects elderly, female, diabetic patients with indwelling urinary devices who are taking antibiotics or have had prior surgical procedures 1
- In asymptomatic patients, candiduria typically represents colonization rather than infection, and elimination of underlying risk factors such as indwelling catheters is often adequate to eradicate candiduria 1
- Removal of an indwelling bladder catheter, when feasible, is strongly recommended as the primary intervention for managing candiduria 1
Catheter Management Recommendations
- Current guidelines do not recommend routine catheter changes at fixed intervals (e.g., every 2-4 weeks) for patients with long-term indwelling urethral or suprapubic catheters 2
- Catheters should be changed based on clinical indications such as blockage, leakage, encrustation, or infection rather than on a fixed schedule 2
- Daily evaluation of the continued need for catheterization is recommended to minimize infection risk and other complications 2
- Urinary catheters should be removed as early as possible when no longer needed 2
Antifungal Treatment Options When Catheter Cannot Be Removed
If catheter removal is not feasible and antifungal treatment is necessary:
- 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 is recommended 1
- For C. krusei, amphotericin B deoxycholate 0.3-0.6 mg/kg daily for 1-7 days is recommended 1
- For patients with fungal cystitis due to fluconazole-resistant species, amphotericin B deoxycholate bladder irrigation with 50 mg/L sterile water daily for 5 days may be considered 3
Catheter Care Best Practices
- A closed catheter drainage system, with ports in the distal catheter for needle aspiration of urine, should be used to reduce catheter-associated bacteriuria and infection 1
- Institution-specific strategies should be developed to ensure that disconnection of the catheter junction is minimized and that the drainage bag and connecting tube are always kept below the level of the bladder 1
- Avoid raising the drainage bag above the level of the bladder as this can facilitate bacterial entry into the bladder 3
- Routine catheter irrigation with normal saline should not be used to reduce catheter-associated bacteriuria, infection, or obstruction 3
- Routine addition of antimicrobials or antiseptics to the drainage bag should not be used to reduce catheter-associated bacteriuria or infection 3
Important Clinical Considerations
- Multiple studies have shown that candiduria is a marker for greater mortality, but death is not related to Candida infection and treatment for Candida infection does not change mortality rates 1
- Candiduria rarely progresses to candidemia in most patient populations 1
- Treatment for asymptomatic candiduria does not appear to reduce candiduria recurrence rates through long-term follow-up 4
- Fluconazole is the antifungal agent of choice for symptomatic Candida urinary tract infections, achieving high urine concentrations with the oral formulation 5
- Newer azole agents and echinocandins are not recommended for the treatment of urinary tract infections since they fail to achieve adequate urine concentrations 5
Special Situations
- Antifungal prophylaxis should be considered when patients with candiduria undergo urinary tract instrumentation due to documented high rates of candidemia in this situation 1
- For patients who experience repeated early catheter blockage from encrustation, some experts have suggested changing catheters every 7-10 days, but this intervention has not been evaluated in clinical trials 2