From the Guidelines
Asymptomatic candiduria in most patients does not require treatment, unless the patient belongs to a high-risk group, such as neutropenic patients, infants with low birth weight, or those undergoing urologic manipulations, as stated in the 2016 update by the Infectious Diseases Society of America 1. The presence of Candida species in the urine, also known as candiduria, can be a significant clinical finding, but its interpretation and management depend on various factors, including the patient's symptoms, underlying medical conditions, and risk factors for disseminated infection.
Key Considerations
- Asymptomatic candiduria is common in catheterized patients and often represents colonization rather than infection 1.
- Treatment is indicated for symptomatic patients, those undergoing urologic procedures, neutropenic patients, and those with renal transplants or high risk for disseminated infection 1.
- Fluconazole is the drug of choice for treating Candida UTI, due to its excellent urinary penetration and efficacy in eradicating candiduria, as shown in a randomized, double-blind, placebo-controlled trial 1.
- For fluconazole-resistant species, options include amphotericin B bladder irrigation or IV echinocandins like caspofungin, although the latter is generally ineffective in treating Candida UTI due to minimal excretion of active drug into the urine 1.
Management Strategies
- Removal of urinary catheters should be attempted whenever possible, as they serve as a nidus for biofilm formation and can contribute to the development of candiduria 1.
- Imaging of the urinary tract by ultrasound or CT scanning can be helpful in defining structural abnormalities, hydronephrosis, abscesses, emphysematous pyelonephritis, and fungus ball formation, which can guide treatment decisions 1.
- The clinical significance of candiduria stems from Candida's ability to form biofilms on catheters and potentially ascend to cause pyelonephritis or enter the bloodstream in immunocompromised hosts, making clinical context crucial in management decisions 1.
From the Research
Clinical Significance of Candida in Urine
The presence of Candida in urine, also known as candiduria, can have significant clinical implications. Some key points to consider include:
- Candiduria is commonly seen in hospitalized patients, particularly those with certain risk factors such as diabetes mellitus, indwelling urinary catheters, and use of broad-spectrum antibiotics 2, 3, 4, 5.
- Most patients with candiduria are asymptomatic, but it can also be a sign of underlying infections such as cystitis, pyelonephritis, prostatitis, or epididymo-orchitis 2, 6.
- The presence of Candida in urine does not always require antifungal therapy, except in certain cases such as neutropenic patients, very low-birth-weight infants, and patients undergoing urologic procedures 2, 3, 4.
Risk Factors and Diagnosis
Some important risk factors and diagnostic considerations include:
- Indwelling urinary catheters and antibiotic use are significant risk factors for candiduria 3, 4, 5.
- Diabetes mellitus is also a major risk factor for candiduria 2, 4.
- Diagnosis of candiduria requires careful evaluation, including verification of funguria by repeating urinalysis and urine culture, and consideration of symptoms and clinical context 6.
- Imaging studies such as ultrasonography and computed tomography (CT) may be useful in evaluating symptomatic or critically ill patients with candiduria 6.
Treatment Options
Treatment options for candiduria include:
- Fluconazole is the antifungal agent of choice, achieving high urine concentrations with oral formulation 2, 3, 4.
- Amphotericin B is an alternative antifungal agent if fluconazole cannot be used due to resistance, allergy, or failure 2, 4.
- Other treatment options such as bladder irrigation with amphotericin B, flucytosine, or parenteral amphotericin B may be considered in certain cases 4.