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🦠 Candiduria: Clinical Significance & Management

**Candiduria** is a **non-specific finding** that may result from:

Contamination of the urine sample
Colonization of the urinary bladder or an indwelling catheter
An **invasive upper urinary tract infection** or cystitis

⚠️ When Does Candiduria Require Antifungal Treatment?

**Asymptomatic candiduria** **does NOT require antifungal treatment** unless the patient:

Is **neutropenic**
Is likely to undergo a **urological procedure**

🧪 Confirming Infection & Further Evaluation

**Cultures should be repeated** to confirm infection, especially if patients exhibit **systemic signs and symptoms**. Additional investigations include:

**Imaging studies** to assess urinary tract abnormalities
**Blood cultures** if systemic involvement is suspected

🚨 Persistent Candiduria in Diabetic Patients

In **sick diabetic patients**, **persistent candiduria** requires **evaluation for complications**, such as:

Hydronephrosis
Fungal balls
Perinephric abscess

💊 Treatment Approach

The **majority of urinary fungal infections** are caused by **Candida albicans**, which is **generally sensitive to Fluconazole**.

**Antifungal considerations:**

**Fluconazole** is the first-line treatment.
**Amphotericin B** is rarely required and should be considered **only if fluconazole resistance is confirmed**.
**Newer azoles & echinocandins are NOT recommended** as they fail to achieve **adequate urinary concentrations**.

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