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candiduria

Candida in the urine. Etiology: - most patients with Foley catheter at time of diagnosis Epidemiolology: - women affected more than men [2] - incidence 2.8/1000 patient days - Candida albicans 66% - Candida glabrata 22% Pathology: - frequently represents colonization rather than infection [9] Laboratory: - urinalysis may show pyruria without bacteriuria - culture positive for Candida Radiology: - symtomatic patients with risk factors for fungus ball - diabetes mellitus, urologic disorders - renal ultrasound or abdominal CT to assess renal involvement Management: 1) patients with Candiduria & chronic foley catheter - no treatment needed other than removing foley catheter - repeat urine culture [6] (why?) - replace foley catheter only when no viable alternative - change foley catheter 2) patients need treatment only if they have candidemia 3) treatment of asymptomatic candiduria only in neutropenic patients & patients undergoing urologic procedures [7] 4) in symptomatic patients who need treatment - flucanzole (oral or IV) - IV amphotericin B for fluconazole resistance - bladder irrigation with amphotericin B not recommended - liposomal amphotericin B does not achieve adequate levels in kidney or bladder 5) mortality of ICU patients with candiduria is 31% [2]

General

candidiasis

References

  1. Veterans Administration, Infectious Disease, Sacramento VAMC
  2. Bougnoux M-E et al, Candidemia and candiduria in critically ill patients admittted to intensive care units in France: Incidence, molecular diveersity, management and outcome. Intensive care Med 2008, 34:292 PMID: 17909746
  3. Kauffman CA et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000 Jan 5; 30:14. PMID: 10619726
  4. Lundstrom T and Sobel J. Nosocomial candiduria: a review. Clin Infect Dis 2001 May 8; 32:1602. PMID: 11340532
  5. Jacobs LG et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. Clin Infect Dis 1996 Jan 1; 22:30. PMID: 8824962
  6. NEJM. Knowledge+ Question of the Week. May 26, 2015
  7. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  8. Revankar SG, Hasan MS, Revankar VS, Sobel JD. Long-term follow-up of patients with candiduria. Eur J Clin Microbiol Infect Dis. 2011 Feb;30(2):137-40. PMID: 20857164
  9. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021