Candiduria

Epidemiology

• Common condition, particularly in patents with:
  • Indwelling urinary catheters
  • Diabetes
  • Recent antibiotic use

Diagnosis and Evaluation

• Often asymptomatic

Natural History

• Usually follows a benign clinical course

Management

• Asymptomatic
  • Indwelling catheters should be removed, is feasible
    • Removal of the indwelling urethral catheter will result in clearance of funguria in 75% of patients within 2 weeks.
  • In catheter-dependent patients, the catheter should be changed and repeat culture should be performed.
    • Changing the catheter can result in resolution of funguria in 20%.
    • When possible, all efforts should be made to change from an indwelling catheter to clean intermittent catheterization as patients with an indwelling catheter are 10 times more likely to have candiduria than those who practice catheterization
  • Persistent candiduria requires work-up for predisposing factors, including PVR assessment to exclude urinary retention, and renal US to look for hydronephrosis, urolithiasis, fungus balls, and renal abscesses.
    • If no predisposing factors are identified, then observation with repeat culture is appropriate (one to three months).
    • Blood cultures for fungi should be obtained in critically ill ICU patients with persistent funguria.
  • Indications for treatment§ (3):
    1. Neutropenic patients
    2. Very low-birth-weight infants (<1500 g)
    3. Patients who will undergo urologic manipulation
• Symptomatic
  • Should be treated.
  • First-line therapy is oral fluconazole, 200 mg daily for 14 days
    • Nearly all urine isolates of Candida albicans and most isolates of Candida glabrata are susceptible to fluconazole. In patients with resistant strains, flucytosine or Amphotericin B may be used.

References

• Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, vol 2, chap 12