Management of asymptomatic candiduria

Candiduria is a common nosocomial infection, occurring predominantly in elderly debilitated subjects with frequent co-morbid pathology, especially diabetes mellitus. The majority of candiduric patients are catheterized or have been recently catheterized or instrumented. Physician surveys indicate considerable variation in attitude towards treatment of asymptomatic candiduria. Management of candiduria is seriously limited by lack of understanding of the natural history of this infection as well as reliable data of treatment efficacy based upon controlled studies. The recent availability of oral antifungal agents has strongly influenced physicians in adopting a more interventional role. Most therapeutic studies quoted in the literature compare active intervention with a variety of systemic or local measures. Reference is made to a recent placebo-controlled prospective study, in which fluconazole was significantly more effective than placebo in short-term eradication of asymptomatic candiduria. Nevertheless, follow-up of these asymptomatic patients revealed identical candiduria rates within 1 month of cessation of therapy. In most studies, evidence of clinical benefit in asymptomatic patients by the eradication of candiduria has not been evident. In conclusion, the majority of hospitalized patients, particularly those with continued catheterization, do not require local or systemic antifungal therapy for asymptomatic candiduria.