Candiduria

[Clin Infect Dis 2009;48:503-35.]

 

- Usually associated with foreign body in urinary tract. Removal of urinary catheter or stent results in ~40% eradication of candiduria but only 20% eradication if catheter/stent subsequently reinserted.

- Persistent candiduria in immunocompromised patients warrants ultrasound or CT of kidney.

- Bladder irrigation with amphotericin B has been used to treat candidal cystitis but does not treat infections beyond the bladder and has a high relapse rate. May be useful for fluconazole resistant Candida species, e.g. C. krusei or C. glabrata.

- Use of echinocandins should be avoided for candiduria due to poor urinary concentrations and limited clinical data.

 
Usual Pathogens

Candida spp

Asymptomatic

Empiric Therapy Dose Duration
Treatment not recommended unless high risk    

Symptomatic/high risk - Cystitis

Empiric Therapy Dose Duration
Fluconazole 200mg (3mg/kg) PO daily 14 days

Alternative

Empiric Therapy Dose Duration
Amphotericin B 0.3-0.6mg/kg IV daily 1-7 days

Symptomatic/High risk - Pyelonephritis

Empiric Therapy Dose Duration
Fluconazole 200-400mg (3-6mg/kg) PO daily 14 days

Alternative

Empiric Therapy Dose Duration
Amphotericin B 0.5-0.7mg/kg IV daily 14 days