Yeast in the urine: solutions for a budding problem

The significance of candiduria ranges from simple procurement-related contamination to disseminated candidiasis. Ensuring that a valid urine specimen is collected and carefully assessing patients for risk factors predisposing to disseminated candidiasis permit the stratification of cases into three clinical categories: (1) asymptomatic candiduria in a previously healthy patient; (2) candiduria in a high-risk patient in whom disseminated candidiasis is unlikely; and (3) candiduria in a high-risk patient with a potential for disseminated candidiasis. Strategies for management are tailored to the individual patient. Appropriate management of anatomic genitourinary abnormalities and removal of bladder catheters may result in the resolution of candiduria, although some patients require systemic antifungal therapy. All patients with candiduria should be evaluated for evidence of deep-seated tissue infection or candidemia before therapy is instituted. Fluconazole appears to be a safe and effective agent for the management of candidal urinary tract infection. Both its safety and its ease of administration make it superior to amphotericin B for this purpose.