Skip to main content
SpringerLink
Log in

Diagnosis and Management of Fungal Urinary Tract Infections

  • Inflammatory/Infectious Bladder Conditions (S Mourad, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Fungal urinary infections are becoming more common, particularly in hospital settings with the vast majority caused by Candida species. The ability to differentiate colonization from infection is difficult and treatment decisions are far from straightforward. To date, there is no dependable method for distinguishing colonization from infection, as evidence of funguria does not automatically require treatment. Often, mere modification of predisposing factors is sufficient management. Following a standardized algorithm that categorizes patients with regard to symptoms and risk profiles can aid the clinician in proper workup and treatment and mitigate unnecessary antifungal usage.

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

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wise GJ. Changing patterns in genitourinary fungal infections. AUA Updat Ser. 1997;16:1–7.

    Google Scholar 

  2. Sobel JD, Fisher JF, Kauffman CA, Newman CA. Candida urinary tract infections--epidemiology. Clin Infect Dis. 2011;52 Suppl 6:S433.

    Article  PubMed  Google Scholar 

  3. Revankar S, Sobel J. Yeast infections of the lower urinary tract: recommendations for diagnosis and treatment. Curr Fungal Infect Rep. 2010;4:175–8.

  4. Bouza E, San Jaun R, Munoz P, Voss A, Kluytmans JA. European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicrobial susceptibility (ESGNI-003 study). European Study Group on Nosocomial Infections. Clin Microbiol Infect. 2001;7:523–31.

    Article  CAS  PubMed  Google Scholar 

  5. Febre N, Silva V, Medeiros EAS, et al. Microbiological characteristics of yeasts isolated from urinary tracts of intensive care unit patients undergoing urinary catheterization. J Clin Microbiol. 1999;37:1584–6.

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Sobel J, Vazquez J. Fungal Infections of the Urinary Tract. World J Urol. 1999;17:410–4.

    Article  CAS  PubMed  Google Scholar 

  7. Lundstrom T, Sobel J. Nosocomial candiduria: a review. Clin Infect Dis. 2001;32:1602–7.

    Article  CAS  PubMed  Google Scholar 

  8. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med. 1999;27:887.

    CAS  PubMed  Google Scholar 

  9. Platt R, Polk BF, Murdock B, et al. Risk factors for nosocomial urinary tract infection. Am J Epidemiol. 1986;124:977–85.

    CAS  PubMed  Google Scholar 

  10. Jarvis WR, Edwards JR, Culver DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991;91:185S–91.

    Article  CAS  PubMed  Google Scholar 

  11. Schaberg DR, Culver AH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991;91(Suppl 3B):72S–5.

    Article  CAS  PubMed  Google Scholar 

  12. Sobel JD, Lundstrom T. Management of Candiduria. Curr Urol Rep. 2001;2:321–5.

    Article  CAS  PubMed  Google Scholar 

  13. Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30:14–8.

    Article  CAS  PubMed  Google Scholar 

  14. Pfaller MA, Diekema DJ, Gibbs DL, et al. Results from the ARTEMIS DISK Global Antifungal Surveillance study, 1997 to 2005: an 8.5-year analysis of susceptibilities of Candida species and other yeast species to fluconazole and voriconazole determined by CLSI standardized disk diffusion testing. J Clin Microbiol. 2007;45:1735.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  15. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48:503–35. Article summarizes the infectious disease society guidelines for management of candida infections.

    Article  CAS  PubMed  Google Scholar 

  16. Spellberg BJ, Filler SG, Edwards Jr JE. Current treatment strategies for disseminated candidiasis. Clin Infect Dis. 2006;42:244.

    Article  CAS  PubMed  Google Scholar 

  17. Costa-de-Oliveira S, Marcos Miranda I, Silva RM, et al. FKS2 mutations associated with decreased echinocandin susceptibility of Candida glabrata following anidulafungin therapy. Antimicrob Agents Chemother. 2011;55:1312.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Pfaller MA, Diekema DJ, Gibbs DL, et al. Candida krusei, a multidrug-resistant opportunistic fungal pathogen: geographic and temporal trends from the ARTEMIS DISK Antifungal Surveillance Program, 2001 to 2005. J Clin Microbiol. 2008;46:515.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23:253–73.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309–17.

    Article  PubMed  Google Scholar 

  21. Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis. 1999;28:1071–9.

    Article  CAS  PubMed  Google Scholar 

  22. Huang CT, Leu HS, Ko WC. Pyuria and funguria [letter]. Lancet. 1995;346(8974):582–3.

    Article  CAS  PubMed  Google Scholar 

  23. Kauffman CA, Fisher JF, Sobel JD, Newman CA. Candida urinary tract infections—diagnosis. Clin Infect Dis. 2011;52 Suppl 6:S452–6.

    Article  PubMed  Google Scholar 

  24. Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol. 2000;21:510–5.

    Article  CAS  PubMed  Google Scholar 

  25. Wainstein MA, Graham Jr RC, Resnick MI. Predisposing factors of systemic fungal infections of the genitourinary tract. J Urol. 1995;154:160–3.

    Article  CAS  PubMed  Google Scholar 

  26. Fisher JF, Kavanaugh K, Sobel JD, Kauffman CA, Newman CA. Candida Urinary Tract Infection: Pathogenesis. Clin Infect Dis. 2011;52(S6):S437–51.

    Article  PubMed  Google Scholar 

  27. Navarro EE et al. Detection of Candida casts in experimental renal candidiasis: implications for the diagnosis and pathogenesis of upper urinary tract infection. J Med Vet Mycol. 1994;32(6):415–26.

    Article  CAS  PubMed  Google Scholar 

  28. Argyle C, Schumann GB, Genack L, Gregory M. Identification of fungal casts in a patient with renal candidiasis. Hum Pathol. 1984;15:480.

    Article  CAS  PubMed  Google Scholar 

  29. Ang BSP, Telenti A, King B, Steckalberg JM, Wilson WD. Candidemia from a urinary tract source: microbiological aspects and clinical signifcance. Clin Infect Dis. 1993;17:622.

    Article  Google Scholar 

  30. Johnson JR, Ireton RC, Lipsy BA: emphesematous pyelonephritis caused by candida albicans. J Urol 1986;551–552.

  31. High KP, Quagliarello VI. Yeast perinephric abscess: A report of a case and review. Clin Infect Dis. 1992;15:128–33.

    Article  CAS  PubMed  Google Scholar 

  32. Mardh PA, Colleen S. Search for uro-genital tract infections in patients with symptoms of prostatitis. Studies on aerobic and strictly anaerobic bacteria, mycoplasmas, fungi, trichomonads, and viruses. Scand J Urol Nephrol. 1975;9:8–16.

    Article  CAS  PubMed  Google Scholar 

  33. Fisher JF. Candiduria: when and how to treat it. Curr Infect Dis Rep. 2000;2:523–30.

    Article  PubMed  Google Scholar 

  34. Fisher JF, Sobel JD, Kauffman CA, Newman CA. Candida Urinary Tract Infections – Treatment. Clin Infect Dis. 2011;52(S6):S457–66. Most up to date review on current treatment guidelines.

    Article  PubMed  Google Scholar 

  35. Bukhary ZA. Candiduria: A Review of Clinical Significance and Management. Saudi J Kid Dis Transp. 2008;19(3):350–60.

    Google Scholar 

  36. Phillips JR, Karlowicz MG. Prevalence of Candida species in hospital acquired urinary tract infections in a neonatal intensive care unit. Pediater Infect Dis J. 1997;16:190–4.

    Article  CAS  Google Scholar 

  37. Williamson MR, Smith AY, Black WC, Rosenberg RD. Diagnosis of candidal infection of the prostate by transrectal ultrasonography and biopsy. J Clin Ultrasound. 1992;20:618–20.

    Article  CAS  PubMed  Google Scholar 

  38. Vibhute PG, Surabhi VR, Gomez A, et al. Radiology of fungal infections. In: Anaissie EJ, McGinnis MR, Pfaller MA, editors. Medical mycology. 2nd ed. London: Churchill Livingstone; 2009. p. 151.

    Google Scholar 

  39. Denning DW. Echinocandin antifungal drugs. Lancet. 2003;362:1142–51. Article focuses on newer antifungal line of therapy, namely echinocandin.

    Article  CAS  PubMed  Google Scholar 

  40. Jacobs LG, Skidmore EA, Freeman K, et al. Oral fluconazole compared with bladder irrigation with amphotericin B for treatment of fungal urinary tract infections in elderly patients. Clin Infect Dis. 1996;22:30.

    Article  CAS  PubMed  Google Scholar 

  41. Simpson C, Blitz S, Shafran SD. The effect of current management on morbidity and mortality in hospitalised adults with funguria. J Infect. 2004;49:248.

    Article  PubMed  Google Scholar 

  42. Kauffman CA. Candiduria. Clin Infect Dis. 2005;41 Suppl 6:S371–6.

    Article  PubMed  Google Scholar 

  43. Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30:19.

    Article  CAS  PubMed  Google Scholar 

  44. Revankar SG, Hasan MS, Revankar VS, Sobel JD. Long term Follow up of patients with candiduria. Eur J Clin Microbiol Infect Dis. 2011;30:137–40. This article highlights the outcomes of managmnet of candida urinary colonization years after initial diagnosis.

    Article  CAS  PubMed  Google Scholar 

  45. Drew RH, Arthur RR, Perfect JR. Is it time to abandon the use of amphotericin B bladder irrigation? Clin Infect Dis. 2005;40:1465–70.

    Article  PubMed  Google Scholar 

  46. van Etten EW, van den Heuvel-de Groot C, Bakker-Woudenberg IA. Efficacies of amphotericin B-desoxycholate (Fungizone), liposomal amphotericin B (AmBisome) and fluconazole in the treatment of systemic candidosis in immunocompetent and leucopenic mice. J Antimicrob Chemother. 1993;32:723–39.

    Article  PubMed  Google Scholar 

  47. High KP, Quagliarello VJ. Yeast perinephric abscess: report of a case and review. Clin Infect Dis. 1992;15:128–33.

    Article  CAS  PubMed  Google Scholar 

  48. Wise GJ, Shteynshyuger A. How to diagnose and treat fungal infections in chronic prostatitis. Curr Urol Rep. 2006;7:320–8.

    Article  PubMed  Google Scholar 

  49. Trapnell J, Roberts M. Prostatic abscess. Br J Surg. 1970;57:565–9.

    Article  CAS  PubMed  Google Scholar 

  50. Fraser VJ, Jones M, Dunkel J, et al. Candidemia in a tertiary care hospital: epidemiology, risk factors, and predictors of mortality. Clin Infect Dis. 1992;15:414.

    Article  CAS  PubMed  Google Scholar 

  51. Nassoura Z, Ivatur RR, Simon RJ, et al. Candiduria as an early marker of disseminated infection in critically ill surgicalpatients: the role of fluconazole therapy. J Trauma. 1993;35:290–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Ehab Eltahawy and Ted Ritchie declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Urology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 540, Little Rock, AR, 72205, USA

    Ted Ritchie & Ehab Eltahawy

Authors
  1. Ted Ritchie
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ehab Eltahawy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ehab Eltahawy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ritchie, T., Eltahawy, E. Diagnosis and Management of Fungal Urinary Tract Infections. Curr Bladder Dysfunct Rep 9, 161–166 (2014). https://doi.org/10.1007/s11884-014-0238-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-014-0238-7

Keywords

Search

Navigation