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. Candida krusei (Pichia kudriavzevii) or Candida glabrata (Nakaseomyces glabrata).
- Use of echinocandins should be avoided for candiduria due to poor urinary concentrations and limited clinical data.
Usual Pathogens
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 |