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Asymptomatic Candiduria
Without a doubt, assessing the significance of a urine culture that has yielded Candida is quite a challenge. Although commonly refered to as "Urinary tract ASYMPTOMATIC colonization" we prefer the term "Insignificant Candiduria", as many cases of pathologic presence of Candida also occur without any symptomatology.
Candida are only rarely found in the urine of healthy individuals. If present at all, colony counts less than 1000 col/ml are found. The incidence of asymptomatic candiduria is higher in girls than boys, which is probably due to vaginal colonization [859]. A single course of antibiotics (erythromycin, amoxacillin, cephalexin, or sulfas) increases the chance of finding yeast in the urine [859]. Pregnancy also increases the rate of colonization, but again this may be related to vaginal colonization [1637, 2301].
The most important risk factors for developing insignificant candiduria in the hospital setting are the presence of a urinary catheter, antimicrobial therapy, age, and diabetes [77, 859, 1171, 2125, 2448]. However, it is very difficult to draw a clear line between the mere presence of Candida in the urine and catheter of one patient and any of the previously discussed causes of candiduria. Therefore, in patients at risk for significant candidura, a systematic approach should be followed.
However, persistent candiduria often goes unexplained. Ultimately, the rule that we follow is to consider the entire patient and setting. If there is a picture potentially compatible with disseminated candidiasis, then empirical therapy for that entity is appropriate. Candiduria in the setting of obstruction should also be treated. Otherwise, mechanical causes of candidura should be corrected and antifungal therapy should be avoided.
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References
77. Ang, B. S. P., A. Telenti, B. King, J. M. Steckelberg, and W. R. Wilson. 1993. Candidemia from a urinary tract source: Microbiological aspects and clinical significance. Clin. Infect. Dis. 17:662-666.
859. Goldberg, P. K., P. J. Kozinn, G. J. Wise, N. Nouri, and R. B. Brooks. 1979. Incidence and significance of candiduria. J. Infect. Dis. 241:582-584.
1171. Kauffman, C. A., J. A. Vazquez, J. D. Sobel, H. A. Gallis, D. S. McKinsey, A. W. Karchmer, A. M. Sugar, P. K. Sharkey, G. J. Wise, R. Mangi, A. Mosher, J. Y. Lee, and W. E. Dismukes. 2000. Prospective multicenter surveillance study of funguria in hospitalized patients. Clin Infect Dis. 30:14-18.
1637. Newmann, G., and U. Kaben. 1975. [Blastomycoid flora of the urogenital tract in nonpregnant and pregnant patients]. Zentralbl Gynakol. 97:372-8.
2125. Sobel, J. D., C. A. Kauffman, D. McKinsey, M. Zervos, J. A. Vazquez, A. W. Karchmer, J. Lee, C. Thomas, H. Panzer, and W. E. Dismukes. 2000. Candiduria: A randomized, double-blind study of treatment with fluconazole and placebo. Clin. Infect. Dis. 30:19-24.
2301. Vejlsgaard, R., J. Bodenhoff, H. Friis, and W. Fischer-Rasmussen. 1982. Occurrence of yeasts in urine from pregnant women. Dan Med Bull. 29:209-10.
2448. Wise, G. J., P. Goldberg, and P. J. Kozinn. 1976. Genitourinary candidiasis: Diagnosis and treatment. J. Urol. 116:778-780.
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