Candida species in Urine (Antimicrobial)

Note that Candida in urine may represent genital candidiasis, which may be evident on clinical examination (see resources: Vulvo-vaginal candidiasis).  Review risk factors for fungal renal tract infection (eg immunosuppression, prosthetic material) and manage as follows:

Asymptomatic candiduria including catheter-associated

Usually represents colonisation therefore antifungal therapy is not routinely recommended except in neutropenia, very low birthweight infants (below 1500g), or urinary tract manipulation. Renal transplantation is not an absolute indication for treatment of asymptomatic candiduria - therapy should be considered on a case-by-case basis. Urinary catheters should be changed and a catheter-free period planned, if possible. Similarly, nephrostomy tubes or stents should be removed/replaced, if feasible.

Recurrent asymptomatic candiduria

May represent colonisation (eg antibiotic use, urinary catheters).  Consider USS or CT of renal tract if patient at increased risk for formation of fungus balls (including diabetics, urologic abnormalities that may predispose to fungus ball formation, and neonates). If so, then discuss with ID/microbiology.

Symptomatic candiduria including upper UTI

Antifungal treatment is indicated when Candida UTI is confirmed (this may require a carefully taken second sample to exclude contamination of the original sample). Urinary catheters should be changed and a catheter-free period planned, if possible. Similarly, nephrostomy tubes or stents should be removed/replaced, if feasible. Discuss with ID/microbiology.

Fluconazole-resistant Candida species

Discuss with ID/Microbiology as there are limited options to achieve high urinary drug levels.

Disseminated candidiasis suspected

Take blood cultures and further investigations as appropriate – discuss with ID/Microbiology.