The Dept of Anaesthesia & Intensive Care, CUHK thanks

for an unrestricted education grant
BASIC instructor/provider course, Hong Kong, July 2nd-4th
Other upcoming courses
Home Feedback Contents

Candiduria in critically ill

Up Candida laryngitis Candida peritonitis Candida pneumonia Candiduria in critically ill Prophylaxis


Updated August 2009 by Charles Gomersall

Candiduria usually represents only colonization although it may reflect systemic candidiasis and in patients with an obstructed urinary tract candiduria may be the source for systemic dissemination.

Asymptomatic candiduria

  • rarely requires treatment but it should be noted that candiduria may be the only microbiological documentation of disseminated candidiasis
  • should be treated in:
    • symptomatic patients
    • neutropaenic patients
    • low birth weight infants
    • patients with renal allografts
    • patients who will undergo urological manipulations
  • 7-14 day courses recommended
  • removal of urinary tract instruments (eg stents, Foley catheters) often helpful. If complete removal not possible placing a new device may be helpful

Regimes

  • fluconazole 200-400 mg/day
  • amphotericin B 0.3-1 mg/kg/day
    • theoretical risk that use of lipid associated formulation, which is designed to reduce nephrotoxicity, may result in decreased delivery of amphotericin to site of action in urinary tract
  • consider oral flucytosine 25 mg/kg 6 hourly for non-albicans Candida in the absence of renal dysfunction
    • emergence of resistance may occur rapidly when flucytosine used as single agent
  • bladder irrigation with amphotericin may transiently clear funguria but is rarely indicated

Symptomatic candiduria

Cystitis

  • fluconazole susceptible species: oral fluconazole 200mg daily for 2 weeks
  • fluconazole resistant: amphotericin B 0.3-0.6 mg/kg daily for 1-7 days or oral flucytosine 25 mg/kg 4 times daily for 7-10 days
  • amphotericin B bladder irrigation generally not recommended but may be useful for fluconazole resistant species, especially C. glabrata

Pyelonephritis

  • Oral fluconazole 200-400 mg daily for 2 weeks
  • Fluconazole resistant species (especially C. glabrata):
    • amphotericin B 0.5-0.7 mg/kg daily ± flucytosine OR
    • flucytosine alone 25 mg/kg 4 times daily
    • 2 weeks treatment

Fungus balls

  • surgical intervention (except neonates)
  • fluconazole 200-400 mg daily OR
  • amphotericin B 0.5-0.7 mg/kg daily ± flucytosine 25 mg/kg 4 times daily
  • if access to renal collecting system available adjunctive therapy using irrigation with amphotericin (50mg/l) in sterile water
  • continue treatment until symptoms resolve and urine cultures negative

Further reading

Pappas PG. Guidelines for treatment of candidiasis: 2009 update by Infectious Diseases Society of Ameria. Clin Infect Dis 2009; 48:503-535


 

©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
Copyright policy    Contributors