Nosocomial Candiduria: A Review

Fungal infections of the urinary tract, especially those caused by Candida species, are becoming increasingly common. Often the line between Candida colonization and infection is blurred. Diagnosis typically depends on the discovery of pyuria with high colony Candida counts in the urine. To date, there have been few studies to have addressed treatment regimens for patients with candiduria. Fluconazole has become a mainstay of therapy; however, questions regarding when to treat, whom to treat, and how long to treat are still largely unanswered. Asymptomatic nosocomial candiduria does not frequently require treatment intervention, because morbidity is low and ascending infection and candidemia are rare complications. Treatment decisions are driven by an understanding of the anatomic site of infection. For Candida cystitis, the first-line treatment is fluconazole, given orally. Ascending pyelonephritis usually requires the administration of a systemic antifungal agent and often requires correction of the obstruction or surgical drainage. More research is needed to define diagnostic criteria and therapeutic pathways. This review will attempt to summarize the state of the art of diagnosis and management of candiduria.