Candida growth (albicans and non-albicans) in urine is common, esp. in hospitalized patients with catheters
Most candiduria is colonization and does NOT require therapy
Most patients have an underlying risk factor, and its management may resolve the candiduria
Instrumentation incl. foley catheter, antimicrobial exposure, diabetes, anatomical abnormality
Consider the possibility of invasive candidiasis or the development of an infection in the upper urinary tract (See red flags below)
Repeat culture to confirm persistence of the organism (may be a contaminant)
Discontinue unnecessary antibacterials and foley catheters
Symptoms/signs attributable to the urinary tract: dysuria, frequency, suprapubic pain/tenderness, flank pain, CVA tenderness
Systemic symptoms not due to another cause
Predisposition: Obstruction or anatomic abnormality, instrumentation
If red flags present, consider imaging of GU tract to evaluate for renal involvement (i.e. fungus ball, papillary necrosis, abscess) or obstruction
Symptoms of cystitis, pyelonephritis, or prostatitis
abnormalities on urinary tract imaging consistent with renal involvement
Suspected disseminated candida infection/candidemia
Prior to urologic procedure
Consider treating in neutropenic patients
Antifungals with inadequate urinary concentration include: Echinocandins (micafungin), lipid formulations of AmB, voriconazole and posaconazole are not recommended for therapy of candida UTI
Catheter removal/replacement.
Fluconazole 200mg PO/IV daily x 2 weeks.
For resistant strains, discuss with ID re: alternatives
Catheter removal/replacement.
Fluconazole 400mg PO/IV daily x 2 weeks.
For resistant strains, discuss with ID re: alternatives
Consult ID and urology
Suspected candidemia in septic patients should be treated with micafungin 100mg IV daily until further data is obtained.
Patient requires a careful examination for relevant findings on fundoscopy, skin exam, and line sites.