Urinary Tract Infxn
Candida in urine Cx

Candida in urine Cx

Candiduria - General

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)

Treatment Approach

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

  1. Symptoms of cystitis, pyelonephritis, or prostatitis

  2. abnormalities on urinary tract imaging consistent with renal involvement

  3. Suspected disseminated candida infection/candidemia

  4. Prior to urologic procedure

  5. Consider treating in neutropenic patients

Therapy (If Indicated)

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.