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Candiduria: Are We Treating Ourselves?

Candiduria is common in hospitalized patients, particularly those with urinary catheters. A variety of treatment options are available, but their relative efficacy and effect on patient outcome is controversial. Two overlapping multicenter studies provide new insight into these issues.

Eight hundred sixty-one patients with funguria were identified over 21 months in a multicenter study sponsored by NIAID and the manufacturer of one of the study drugs. Most had underlying disease; diabetes (39%) and urinary tract abnormalities (38%) were most common. Urethral catheters were present in 78% of patients; only 2% to 4% had symptoms of funguria. Urinalysis revealed pyuria in more than half and >50 WBC/HPF in 20%. Candida albicans (52%) and C. glabrata (16%) were the most common isolates. Fifty-seven percent of patients were not treated; 19% received fluconazole only; 12% received amphotericin B bladder irrigation only; 5% were treated with IV amphotercin B (with or without bladder irrigation); and 7% received some combination of amphotericin B and fluconazole.

Among the 62% who had follow-up cultures, candiduria cleared in 76% who were given no therapy, compared with 35% whose only treatment was catheter removal and 50% treated with antifungal drugs (with or without catheter removal). Only 7 patients developed candidemia, and although overall patient mortality was 20%, only 2 patients were believed to have died because of candida infection.

In the second study, 75 of the original group plus an additional 241 patients were prospectively randomized to daily treatment with 200 mg of fluconazole or placebo. Catheters (if present) were replaced.

Of the 316 patients treated with fluconazole, 50% became culture-negative, compared with 29% of placebo recipients. Clearance rates were more than 50% higher in the fluconazole-treated patients lacking an indwelling catheter. Diabetes did not influence response, but presence of C. tropicalis predicted lower response, as did elevated creatinine levels. Although eradication rates with fluconazole were better initially, after 2 weeks there was no difference between the groups.

Comment: Candidemia and mortality secondary to candiduria are both rare, even in the absence of therapy. Catheter removal is probably the most efficacious intervention. Although drug treatment may alleviate candiduria initially, most patients probably do not benefit from therapy. Identifying those who might remains a challenge. Although fluconazole and amphotericin bladder wash have similar short-term efficacy, fluconazole's convenience is a significant plus.

— B Britigan

Published in Journal Watch Infectious Diseases March 1, 2000

Citation(s):

Kauffman CA et al. Prospective multicenter surveillance study of funguria in hospitalized patients. Clin Infect Dis 2000 Jan 30 14-18.

• Medline abstract (Free)

Sobel JD et al. Candiduria: A randomized double-blind study of treatment with fluconazole and placebo. Clin Infect Dis 2000 Jan 30 19-24.

• Medline abstract (Free)