Clinicians' reaction to positive urine culture for Candida organisms

Clinicians' reaction to isolating Candida organisms in urine culture (> or = 10(4) CFU ml-1) was assessed in a retrospective review of 133 consecutive in-patients (> or = 15 years-of-age) over a 5 month period. The average age was 68.8 years and male/female ratio was 0.36 (35/98). Most (78.2%) patients had an indwelling catheter, and many (35.3%) were in the intensive care unit (ICU). In response to culture-result, clinicians initiated antifungal therapy in 80 instances (60.2%). Treatment was often based on a single culture without documenting the infection (n = 53/80, 66.3%) in the absence of risk for invasive disease. Removing the indwelling-catheter was never attempted and antibiotics were rarely discontinued or modified (1.3%). Fluconazole was most frequently utilized (n = 42, 52.5%), followed by amphotericin-B bladder-irrigation (n = 26, 32.5%), and combined fluconazole/amphotericin-B bladder-irrigation (n = 12, 15%). Therapy was more frequently initiated in ICU-cases (76.6 versus 55.6%; P = 0.023) and less often in non-catheterized individuals (40.7 versus 69%; P = 0.012) and patients with 10(4) CFU ml-1 (25.9 versus 72.7%; P < 0.0001). These findings show that clinicians nowadays do not follow current guidelines for the management of candiduria. Efforts to increase clinicians' awareness of these guidelines, which are intended to confirm the diagnosis and stratify treatment according to patient risk factors, appear to be necessary.