How is fungal UTI diagnosed and treated?
Risk factors for fungal UTI include exposure to broad-spectrum antimicrobial therapy, the presence of diabetes, and the use of chronic indwelling catheters. Candida albicans is the most common organism; other Candida spp. may also be isolated. Most of these patients are asymptomatic, and asymptomatic funguria should not be treated.
Fluconazole has good urinary excretion and is the treatment of choice for symptomatic infection. For species, such as C. glabrata, which are resistant to fluconazole, the recommended alternate treatment is amphotericin B deoxycholate. 5-flucytocine may also be effective but has substantial side effects and requires monitoring of drug levels when used. Other azoles and echinocandins do not achieve therapeutic concentrations in the urine and are not recommended for treatment of urinary infection. Patients with an inadequate therapeutic response to appropriate antifungal therapy should have imaging studies to exclude a fungus ball which, if present, requires surgical intervention.
