Candiduria: Evidence-based approach to management, are we there yet?

Area of Science:

• Medical Mycology
• Infectious Diseases
• Urology

Background:

• Candiduria diagnosis and treatment lack standardization, complicated by Candida's commensal status and non-bacterial UTI criteria.
• Historical management approaches have evolved, with recent guidelines noting increased incidence of resistant non-albicans Candida species.

Purpose of the Study:

• To review the diagnostic challenges and evolving management strategies for candiduria.
• To highlight the importance of clinical context in determining antifungal therapy for candiduria.

Main Methods:

• Literature review of diagnostic criteria and treatment guidelines for candiduria.
• Analysis of risk factors, including urinary catheterization, antibiotic use, and diabetes.
• Evaluation of antifungal agents, focusing on urinary excretion and efficacy.

Main Results:

• Candiduria diagnosis is ambiguous due to lack of specific lab criteria and Candida's role as a genitourinary commensal.
• Long-term catheterization, antibiotic use, and diabetes are significant risk factors for candiduria.
• Fluconazole is a primary treatment due to efficacy and safety; other agents like amphotericin B and flucytosine have specific applications.

Conclusions:

• Effective management of candiduria requires careful clinical assessment to differentiate colonization from infection.
• Antifungal therapy choice depends on clinical factors, patient status, and drug properties like urinary excretion.
• Emerging resistant strains necessitate ongoing research into optimal diagnostic and therapeutic approaches for candiduria.