Candida Urinary Tract Infections—Treatment

Fisher, John F.; Sobel, Jack D.; Kauffman, Carol A.; Newman, Cheryl

doi:10.1093/cid/cir112

Cited by 176 publications

(186 citation statements)

References 90 publications

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“…Current guidelines recommend no treatment for asymptomatic candiduria and treatment with antifungals for symptomatic individuals [14,15]. Complications such as candidaemia, fungal balls and pyelonephritis are rare in healthy individuals, which makes this case unique.…”

Section: Discussionmentioning

confidence: 99%

Candida glabrata Sepsis in an Immunocompetent Individual: A Case Report

Tan¹,

Reddy²,

Gupta³

et al. 2017

Gynecol Obstet Case Rep

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Candidaemia accounts for a significant proportion of systemic fungal infections, with Candida glabrata (C. glabrata) becoming prominent in recent decades. We describe a unique case where postoperative urinary retention and C. glabrata UTI led to invasive fungaemia with bladder necrosis. A 37-year-old previously well nulliparous woman underwent an elective diagnostic laparoscopy, hysteroscopy dilation and curettage, and dye studies for investigation of infertility. She re-presented six days post procedure with C. glabrata urosepsis with a subsequent laparoscopy on day 16 revealing fungal plaques in the bladder, and a large necrotic defect in the bladder dome. The patient was managed with bilateral nephrostomies, a pelvic drain and antifungal therapy. Four weeks post-insertion of the nephrostomies, a cystogram revealed spontaneous closure of bladder defect. The nephrostomies were removed and antibiotics and antifungals continued for a month until negative urine cultures were attained. The patient was well four months after discharge with mild urinary symptoms. The literature has reported two cases of candida UTIs resulting in bezoars and bladder rupture, occurring only in immunocompromised patients. This case highlights the challenges of C. glabrata sepsis and its potential for severe morbidity in a non-immunocompromised patient, suggesting the need for guidelines in the early detection and treatment of C. glabrata sepsis.

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Section: Discussionmentioning

confidence: 99%

Candida glabrata Sepsis in an Immunocompetent Individual: A Case Report

Tan¹,

Reddy²,

Gupta³

et al. 2017

Gynecol Obstet Case Rep

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“…Symptomatic patients and asymptomatic patients at high risk of dissemination (e.g., immunocompromised patients) require antifungal therapy in addition to adequate source control. FLC and AMB are first-line treatment options for Candida urinary tract infections, since echinocandins and other azoles (itraconazole, voriconazole, and posaconazole) have limited excretion into the urine (35). With the increasing frequency of FLC-resistant Candida strains isolated in urine and the high rates of toxicity associated with AMB, there is a clear need for novel agents that effectively treat Candida urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Analysis of Finasteride Activity against Candida albicans Urinary Biofilm Formation and Filamentation

Chavez-Dozal

Lown

Jahng

et al. 2014

Antimicrob Agents Chemother

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cCandida albicans is the 3rd most common cause of catheter-associated urinary tract infections, with a strong propensity to form drug-resistant catheter-related biofilms. Due to the limited efficacy of available antifungals against biofilms, drug repurposing has been investigated in order to identify novel agents with activities against fungal biofilms. Finasteride is a 5-␣-reductase inhibitor commonly used for the treatment of benign prostatic hyperplasia, with activity against human type II and III isoenzymes. We analyzed the Candida Genome Database and identified a C. albicans homolog of type III 5-␣-reductase, Dfg10p, which shares 27% sequence identity and 41% similarity to the human type III 5-␣-reductase. Thus, we investigated finasteride for activity against C. albicans urinary biofilms, alone and in combination with amphotericin B or fluconazole. Finasteride alone was highly effective in the prevention of C. albicans biofilm formation at doses of >16 mg/liter and the treatment of preformed biofilms at doses of >128 mg/liter. In biofilm checkerboard analyses, finasteride exhibited synergistic activity in the prevention of biofilm formation in a combination of 4 mg/liter finasteride with 2 mg/liter fluconazole. Finasteride inhibited filamentation, thus suggesting a potential mechanism of action. These results indicate that finasteride alone is highly active in the prevention of C. albicans urinary biofilms in vitro and has synergistic activity in combination with fluconazole. Further investigation of the clinical utility of finasteride in the prevention of urinary candidiasis is warranted.

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“…En pacientes críticos, la candiduria se considera un marcador de una probable candidiasis invasora; por otro lado, el riñón puede llegar a infectarse en 80% de los pacientes adultos con candidemia y la candiduria, por lo tanto, es resultado de esta infección hematógena 1 . La presencia de sangre, proteínas y piuria en el sedimiento de orina orienta a una ITU por levaduras 2 . En relación a la epidemiología de la candiduria, Candida albicans es la especie más frecuente, seguida de Candida tropicalis.…”

Section: As Infecciones Del Tracto Urinario (Itu) Porunclassified