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Diagnosis of candiduria is based on the presence of Candida spp in 2 consecutive urine cultures. Risk factors include diabetes mellitus, indwelling catheters, and antibiotics. The presence of Candida spp in urine usually indicates colonization rather than infection. However, these two clinical situations cannot be distinguished from each other solely on the basis of quantitative urine cultures and the presence or absence of leukocyturia, as the latter can be present in the absence of an active infection.
In the majority of patients, asymptomatic candiduria requires no treatment, with the exception of those who undergo invasive surgical procedures involving the urinary tract, and may be considered for severely immunocompromised patients such as neutropenic patients. In patients at risk for disseminated candidiasis in whom continued catheterization is indicated, replacement of the catheter or intermittent catheterization instead of the indwelling catheter can be considered. Asymptomatic candiduria usually resolves following removal of the catheter or discontinuation of antibiotic therapy.
In rare cases, candiduria may be a sign of kidney infection, which almost always results from hematogenous spread secondary to candidemia and manifests as multiple microabscesses that can be visualized on computed tomography (CT) scans.
Treatment of symptomatic candiduria (dose and duration depending on severity and treatment response): Oral fluconazole 200 to 400 mg/d for 7 to 14 days or IV amphotericin B 0.5 to 0.7 mg/kg for 1 to 7 days (14 days for pyelonephritis).
Treatment of asymptomatic candiduria in patients undergoing urologic procedures: Oral fluconazole 200 to 400 mg/d or amphotericin B IV 0.3 to 0.6 mg/kg for a few days before and after surgery.
Treatment of symptomatic candiduria in individuals with neutropenia: As in candidemia: see Candidemia in Patients With Neutropenia (Candidiasis).