Skip to main content
SpringerLink
Log in

Candidurie! Was nun?

Zur Therapie von Harnwegsinfektionen durch Candida

Candiduria! What now?

Therapy of urinary tract infections with Candida

  • Originalien
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Man findet Candida spp. recht häufig im Urin v. a. im Alter und bei Patienten unter Therapie mit Breitspektrumantibiotika also besonders bei Patienten auf Intensivstationen. Gelegentlich ist die Keimzahl sogar recht hoch, d. h. >105/ml. Die klinische Relevanz eines Nachweises von Candida im Urin ist nicht mit Sicherheit zu beurteilen. In der deutschen S3-Leitlinie wird zwar apodiktisch behauptet wird, dass es keine aszendierende Harnwegsinfektion durch Candida gibt. Zweifellos kann dies aber durchaus bei Risikopatienten, z. B. im Alter, Diabetes oder Fremdkörper im Harntrakt, geschehen. Nach hämatogener Aussaat kann eine Pyelonephritis entstehen, die mit Candidurie einhergeht. In seltenen Fällen kann auch eine Prostatitis und Epididymitis dazu führen. Eine Therapiebedürftigkeit ergibt sich auf alle Fälle, wenn urologische Manipulationen, speziell solche mit schleimhautverletzenden Prozeduren, geplant sind, um eine intraoperative Verschleppung der pathogenen Keime zu vermeiden.

Zielsetzung

Nur wenige Antimykotika sind zur Therapie von Candidurie geeignet, nämlich Flucytosin, konventionelles Amphotericin B, das auch zur Irrigation zum Einsatz kommt, und Fluconazol.

Material und Methode

Die In-vitro-Wirkung von Nitroxolin gegen 100 Isolate von Sprosspilzen aus dem Urin wurde mittels Agardiffusion geprüft.

Ergebnisse

Nitroxolin hat eine gute Aktivität gegen alle getesteten Sprosspilze.

Diskussion

Das Antibiotikum Nitroxolin hat eine gute antifungale Wirkung. Es erreicht dazu hohe Wirkkonzentrationen im Urin, es wirkt auch bei niedrigem pH und sogar auf pathogene Keime im Biofilm, was die Antimykotika meist nicht können. Nitroxolin ist also zur Beendigung einer Candidurie geeignet. Fremdkörper in den Harnwegen, auf denen sich Biofilme bilden, sollten womöglich entfernt werden.

Abstract

Background

Yeasts are found in urine specimens relatively often, especially in the elderly and patients under treatment with broad spectrum antibiotics, i. e. especially in intensive care unit (ICU) patients. In some cases, the number of pathogens is very high, i. e. >105/ml. The clinical relevance of detecting Candida in urine is difficult to assess. In the German S3 guidelines it is apodictically stated that an ascending infection of the urinary tract by yeasts does not occur but this may undoubtedly happen in certain instances in patients at risk, for example in the elderly, in diabetic persons and in the case of foreign bodies in the urinary tract. A hematogenous spread of yeasts can lead to pyelonephritis, which accompanies candiduria. In rare cases this can be induced by prostatitis and epididymitis. Therapy is indicated in all cases when a urological manipulation is planned, particularly those with injury to the mucosal barrier, in order to prevent an intraoperative spread of pathogens.

Aim

The antimicrobial agents suitable for therapy of candiduria are limited, namely flucytosine, amphotericin B, which is also used for irrigation and fluconazole.

Material and Methods

The in vitro effect of nitroxoline on 100 isolates of yeasts from urine was tested by an agar diffusion test.

Results

Nitroxoline exerted a good activity against all yeast isolates.

Discussion

The antibiotic nitroxoline has a good antifungal activity. It achieves high concentrations in urine and in addition, it is effective at low pH as well as against pathogens in biofilms, which most antimycotics cannot achieve. Hence, nitroxoline is suitable for termination of candiduria. Foreign bodies in the urinary tract, on which biofilms are formed, should be removed whenever possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Achkar JM, Fries BC (2010) Candida infections of the genitourinary tract. Clin Microbiol Rev 23:253–273

    Article  PubMed  PubMed Central  Google Scholar 

  2. AWMF (2010) S‑3 Leitlinie AWMF-Register-Nr. 043/044. Harnwegsinfektionen. Epidemiologie, Diagnostik, Therapie und Management unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Langfassung 17. Juni 2010

  3. Bekersky I, Fielding RM, Dressler DE et al (2002) Pharmacokinetics, excretion, and mass balance of liposomal amphotericin B (AmBisome) and amphotericin B deoxycholate in humans. Antimicrob Agents Chemother 46:828–833

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Bergogne-Berezin E, Berthelot G, Muller-Serieys C (1987) Present status of nitroxoline. Pathol Biol (Paris) 35:873–878

    CAS  Google Scholar 

  5. Cancet B, Amgar A (1987) Activité antifongique de la nitroxoline in vitro. Résultats cliniques préliminaires. Pathol Biol (Paris) 35:879–881

    CAS  Google Scholar 

  6. Chen SC, Tong ZS, Lee OC et al (2008) Clinician response to Candida organisms in the urine of patients attending hospital. Eur J Clin Microbiol Infect Dis 27:201–208

    Article  CAS  PubMed  Google Scholar 

  7. Costa-de-Oliveira S, Miranda IM, Silva-Dias A et al (2015) Ibuprofen potentiates the in vivo antifungal activity of fluconazole against Candida albicans murine infection. Antimicrob Agents Chemother 59:4289–4292

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Danby CS, Boikov D, Rautemaa-Richardson R et al (2012) Effect of pH on in vitro susceptibility of Candida glabrata and Candida albicans to 11 antifungal agents and implications for clinical use. Antimicrob Agents Chemother 56:1403–1406. doi:10.1128/AAC.05025-11

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Delgado J, Calvo N, Gomis A (2010) Candiduria in renal transplant recipients: incidence, clinical repercussion, and treatment indication. Transplant Proc 42:2944–2946

    Article  CAS  PubMed  Google Scholar 

  10. Demontrond D, Steinmetzt P, Bernard PF (1986) Infections urinaires à levures. Traitement par la nitroxoline chez 15 patients. Bull Soc Fr Mycol Med 15:307–310

    Google Scholar 

  11. Dorsthorst te DT, Verweij PE, Meis JF et al (2005) Relationship between in vitro activities of amphotericin B and flucytosine and pH for clinical yeast and mold isolates. Antimicrob Agents Chemother 49:3341–3346

    Article  Google Scholar 

  12. Dufour A, Bollack C (1979) De la pénétration de la nitroxoline dans le parenchyme prostatique. Essai thérapeutique. J Urol Nephrol 3:207–212

    Google Scholar 

  13. Fisher JF, Sobel JD, Kauffman CA et al (2011) Candida urinary tract infections-treatment. Clin Infect Dis 52(Suppl 6):457–466

    Article  Google Scholar 

  14. Fisher JF, Woeltje K, Espinel-Ingroff A (2003) Efficacy of a single intravenous dose of amphotericin B for Candida urinary tract infections: further favorable experience. Clin Microbiol Infect 9:1024–1027

    Article  CAS  PubMed  Google Scholar 

  15. Focht J, Nösner K (1995) In-vitro-Wirksamkeit von Nitroxolin gegen Candida. Extr Urol 18:294–296

    Google Scholar 

  16. Fong IW (1995) The value of a single amphotericin B bladder washout in candiduria. J Antimicrob Chemother 36:1067–1071

    Article  CAS  PubMed  Google Scholar 

  17. Helbig S, Achkar JM, Jain N et al (2013) Diagnosis and inflammatory response of patients with candiduria. Mycoses 56:61–69

    Article  CAS  PubMed  Google Scholar 

  18. Hernández Molina JM, Llosá J, Ventosa A (1991) In vitro activity of nitroxoline against clinical isolates of Candida species. Mycoses 34:323–325

    Article  PubMed  Google Scholar 

  19. Herrero-Martínez JM, Lumbreras C, Manrique A et al (2013) Epidemiology, risk factors and impact on long-term pancreatic function of infection following pancreas-kidney transplantation. Clin Microbiol Infect 19:1132–1139

    Article  PubMed  Google Scholar 

  20. Hof H, Bertsch D, Passek D, Schwarz R. (2016) Nitroxolin – eine Option zur antibiotischen Therapie von Harnwegsinfektionen. (eingereicht)

  21. Hof H, Schütt S (2014) Nachweis von Candida spp. bei Patienten in hohem Alter. Was nun? Klinikarzt 43:372–375

    Article  Google Scholar 

  22. Ingersoll MA, Albert ML (2013) From infection to immunotherapy: host immune responses to bacteria at the bladder mucosa. Mucosal Immunol 6:1041–1053

    CAS  PubMed  Google Scholar 

  23. Kuhn DM, George T, Chandra J et al (2002) Antifungal susceptibility of Candida biofilms: unique efficacy of amphotericin B lipid formulations and echinocandins. Antimicrob Agents Chemother 46:1773–1780

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Lenzner A (1983) Orale Behandlung von Pilzerkrankungen des Harntraktes mit Nitroxolin. Therapiewoche 33:735–738

    Google Scholar 

  25. Lichtenstern C, Wolff M (2011) Management invasiver Mykosen in der Intensivmedizin. In: Weigand MA, Hoppe-Tichy T (Hrsg) Invasive Mykosen in der Intensivmedizin – ein Leitfaden für die Praxis mit Fallbeispielen. Uni-med, Bremen, S 47–66

    Google Scholar 

  26. Lichtenstern C, Swoboda S, Hirschburger M et al (2010) Update: invasive fungal infections: diagnosis and treatment in surgical intensive care medicine. Anaesthesist 59:30–52

    Article  CAS  PubMed  Google Scholar 

  27. Malani AN, Kauffman CA (2007) Candida urinary tract infections: treatment options. Expert Rev Anti Infect Ther 5:277–284

    Article  CAS  PubMed  Google Scholar 

  28. Marr KA, Rustad TR, Rex JH et al (1999) The trailing end point phenotype in antifungal susceptibility testing is pH dependent. Antimicrob Agents Chemother 43:1383–1386

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Michel-Nguyen A, Nourrit J, Penaud A, Nicoli RM (1986) Nitroxoline et antifongiques traditionnels: comparaison de leur activité antifongique contre 238 souches de levures. Bull Soc Fr Mycol Med 15:265–268

    Google Scholar 

  30. Nicolle LE (2005) Complicated urinary tract infection in adults. Can J Infect Dis Med Microbiol 16:349–360

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Pappas PG, Kauffman CA, Andes DR et al (2016) Clinical practice guideline for the management of Candidiasis: 2016 update by the infectious diseases society of America. Clin Infect Dis 62(e1):e50

    Google Scholar 

  32. Pelletier C, Prognon P, Bourlioux P (1995) Roles of divalent cations and pH in mechanism of action of nitroxoline against Escherichia coli strains. Antimicrob Agents Chemother 39:707–713

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Rishpana MS, Kabbin JS (2015) Candiduria in catheter associated urinary tract infection with special reference to biofilm production. J Clin Diagn Res 9:C11–3

    Google Scholar 

  34. Rivera-Sanchez R, Delgado-Ochoa D, Flores-Paz RR et al (2010) Prospective study of urinary tract infection surveillance after kidney transplantation. BMC Infect Dis 10:245

    Article  PubMed  PubMed Central  Google Scholar 

  35. Singer S, Oberdorfer K, Schwarz R et al (2013) Kalkulierte Antibiotikatherapie von Harnwegsinfektionen bei älteren Frauen – Stellenwert von Ciprofloxacin und anderen Chinolonen. Gynakologe 46:847–857

    Article  CAS  Google Scholar 

  36. Sinnollareddy M, Peake SL, Roberts MS et al (2011) Pharmacokinetic evaluation of fluconazole in critically ill patients. Expert Opin Drug Metab Toxicol 7:1431–1440

    Article  CAS  PubMed  Google Scholar 

  37. Sobel JD, Fisher JF, Kauffman CA et al (2011) Candida urinary tract infections-epidemiology. Clin Infect Dis 52(Suppl 6):433–436

    Article  Google Scholar 

  38. Sobke A, Klinger M, Hermann B et al (2012) The urinary antibiotic 5‑nitro-8-hydroxyquinoline (Nitroxoline) reduces the formation and induces the dispersal of pseudomonas aeruginosa biofilms by chelation of iron and zinc. Antimicrob Agents Chemother 56:6021–6025

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Tobudic S, Kratzer C, Lassnigg A et al (2012) Antifungal susceptibility of Candida albicans in biofilms. Mycoses 55:199–204

    Article  PubMed  Google Scholar 

  40. Tuon FF, Amato VS, Penteado Filho SR (2009) Bladder irrigation with amphotericin B and fungal urinary tract infection-systematic review with meta-analysis. Int J Infect Dis 13:701–706

    Article  CAS  PubMed  Google Scholar 

  41. Udayalaxmi J, Jacob S, D’Souza D (2014) Comparison between virulence factors of Candida albicans and non-albicans species of Candida isolated from genitourinary tract. J Clin Diagn Res 8:C15–7

    Google Scholar 

  42. Valdez-Ortiz R, Sifuentes-Osornio J, Morales-Buenrostro LE et al (2011) Risk factors for infections requiring hospitalization in renal transplant recipients: a cohort study. Int J Infect Dis 15:e188–e196

    Article  PubMed  Google Scholar 

  43. Viale P (2009) Candida colonization and candiduria in critically ill patients in the intensive care unit. Drugs 69(Suppl 1):51–57

    Article  PubMed  Google Scholar 

  44. Wagenlehner FM, Münch F, Pilatz A et al (2014) Urinary concentrations and antibacterial activities of nitroxoline at 250 milligrams versus trimethoprim at 200 milligrams against uropathogens in healthy volunteers. Antimicrob Agents Chemother 58:713–721

    Article  PubMed  PubMed Central  Google Scholar 

  45. Wildfeuer A, Laufen H, Schmalreck AF et al (1996) Fluconazole: comparison of pharmacokinetics, therapy and in vitro susceptibility of yeasts. Mycoses 39(Suppl 2):51–57

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MVZ Labor Dr. Limbach und Kollegen, Im Breitspiel 15, 69126, Heidelberg, Deutschland

    H. Hof

Authors
  1. H. Hof
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Hof.

Ethics declarations

Interessenkonflikt

H. Hof gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von dem Autor durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hof, H. Candidurie! Was nun?. Urologe 56, 172–179 (2017). https://doi.org/10.1007/s00120-016-0219-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-016-0219-x

Schlüsselwörter

Keywords

Search

Navigation