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.
Asymptomatic candiduria where urinary tract manipulation is planned.
Discuss patients with neutropenia or very low birthweight infants (under 1500g) with ID/Microbiology.
Fluconazole 400mg daily
Several days before and after the procedure (eg 3 days before and after)
Lower UTI/cystitis due to fluconazole-susceptible Candida spp.
Fluconazole 200mg daily