Clinical Description, Epidemiology, and Etiology
Fungal UTI, an increasingly frequent problem, is generally limited to hosts with an obvious predisposing factor such as diabetes mellitus, antibiotic therapy, and/or indwelling bladder catheter use (53). Candida species predominate overwhelmingly as the causative agents, with Aspergillus and other fungi only rarely causing UTI, and then only in profoundly immunocompromised hosts.
The great majority of fungal UTIs are asymptomatic and, like catheter-associated UTI (which many fungal UTIs are), require no specific diagnostic testing or antifungal therapy [B] (53-57). Although the morbidity and mortality associated with funguria are considerable, this is due primarily to the comorbid conditions that are commonly present in patients who develop funguria (53,54). Complications attributable to fungal UTI per se are rare (53,58). When treatment is judged to be necessary because of clinical manifestations of infection, fluconazole is usually the treatment of choice [A] (53,59-61). It should be given orally in patients able to tolerate and absorb oral medications [C]. Bladder washout with amphotericin B cannot be recommended, as it is more cumbersome and noxious than fluconazole, may be less effective even for infections limited to the bladder (57,60-62), and would be expected to fail when the infection is tissue invasive, involves the upper urinary tract, or has spread (or initially originated) outside of the urinary tract. The latter possibility is important to consider in critically ill patients with funguria, in whom funguria may be a harbinger of incipient or established disseminated candidiasis [B] (53,63-65). Although routine preemptive antifungal therapy for critically ill surgical patients with funguria has been advocated (65), whether this approach truly improves outcomes remains to be definitively determined [C].
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