Candida UTIs in adults (World Journal of Urology) Flashcards
What is candiduria?
The presence of Candida species in urine, commonly seen in hospitalized patients.
What are the major risk factors for candiduria?
- Diabetes mellitus
- Indwelling urinary catheters
- Use of broad-spectrum antibiotics
- Urinary obstruction
- Admission to intensive care units
What are the potential causes of Candida urinary tract infections?
- Cystitis
- Pyelonephritis
- Prostatitis
- Epididymo-orchitis
- Disseminated candidiasis
- Hematogenous spread following candidemia
- Retrograde route via the urethra
When is antifungal therapy warranted in patients with candiduria?
In asymptomatic patients, antifungal therapy is not recommended except in:
* Neutropenic patients
* Very low-birth-weight infants
* Patients undergoing urologic procedures
What is the treatment of choice for symptomatic Candida infections?
Fluconazole, as it achieves high urinary levels.
Which antifungal agents do not reach sufficient urine levels?
- Other azole antifungals
- Echinocandins
What is an alternative antifungal agent if fluconazole cannot be used?
Amphotericin B deoxycholate.
What percentage of urine cultures in hospitals are positive for Candida spp.?
1% of urine cultures positive for any pathogen.
What is the incidence of candiduria in critically ill patients admitted to ICUs for more than 7 days?
22%.
What is the significance of candiduria in terms of in-hospital mortality?
In-hospital mortality is significantly higher in patients with candiduria compared to those without (48.8% vs 36.6%).
Which Candida species is most commonly associated with candiduria?
C. albicans.
What are the two main mechanisms for the invasion of the urinary tract by Candida spp.?
- Hematogenous dissemination to kidneys (antegrade infection)
- Ascending route through urethra and bladder (retrograde infection)
True or False: Candiduria is usually symptomatic.
False. Most candiduric patients are asymptomatic.
What clinical manifestations may indicate a Candida urinary tract infection?
- Dysuria
- Frequency
- Urgency
- Flank pain
- Hematuria
What factors increase the risk of developing candidemia after candiduria?
- Hospitalizations greater than 12 days
- Central venous catheter
- Parenteral nutrition
- Hematological malignancy
- Gynecological malignancy
- Receipt of beta-lactam/beta-lactamase inhibitors
What is the typical presentation of Candida prostatitis and epididymo-orchitis?
May present with symptoms similar to bacterial infections, often affecting elderly patients.
What is the occurrence of candiduria in renal transplant patients?
Around 3.4–11%, usually clinically asymptomatic.
Fill in the blank: The presence of Candida in urine may be due to _______.
[Contamination, colonization, urinary tract infection, cystitis, pyelonephritis, renal candidiasis, fungus ball, candidemia, prostatitis, epididymo-orchitis]
What are the common risk factors for Candida urinary tract infections?
- Diabetes mellitus
- Urinary indwelling catheters
- Antibiotics
- Urinary tract abnormalities
- ICU admission
- Urinary tract surgery
- Obstructive uropathy/lithiasis
- Advanced age (> 65)
- Renal transplantation
- Female sex
- Major abdominal surgery
- Total parenteral nutrition
- Mechanical ventilation
- Immunosuppression
- Malignancy
What is the association between candiduria and candidaemia in studies?
Candiduria is not a good predictor for candidemia or disseminated candidiasis.
What is the significance of C. glabrata in candiduria cases?
It may be resistant to fluconazole or susceptible to higher dosages.
What is the typical management for asymptomatic candiduria in hospitalized patients?
It is sufficient to correct underlying risk factors or remove/replace indwelling catheters.
What is the definition of candiduria?
Candiduria is defined as at least one culture of urine that yielded ≥ 1 × 103 to > 1 × 104 Candida colonies/ml.
What are common symptoms of Candida epididymo-orchitis?
Bilateral presentation, prolonged symptoms ranging from 5 days to 5 months.
