Management of Indwelling Catheters for Controlling Candiduria

Understanding Candiduria with Indwelling Catheters

Candiduria most commonly affects elderly, female, diabetic patients with indwelling urinary devices who are taking antibiotics or have had prior surgical procedures 1, 2
In asymptomatic patients, candiduria typically represents colonization rather than infection, and elimination of underlying risk factors such as indwelling catheters is often adequate to eradicate candiduria 1, 2
Removal of an indwelling bladder catheter, when feasible, is strongly recommended as the primary intervention for managing candiduria 1, 2

Current guidelines do not recommend routine catheter changes at fixed intervals for patients with long-term indwelling urethral or suprapubic catheters 3
Catheters should be changed based on clinical indications such as blockage, leakage, encrustation, or infection rather than on a fixed schedule 3
Daily evaluation of the continued need for catheterization is recommended to minimize infection risk and other complications 3
Urinary catheters should be removed as early as possible when no longer needed 3

For fluconazole-susceptible organisms, oral fluconazole 200 mg daily for 2 weeks is recommended 1, 2
For fluconazole-resistant C. glabrata, amphotericin B deoxycholate or oral flucytosine is recommended 1, 2
For C. krusei, amphotericin B deoxycholate is recommended 1, 2

A closed catheter drainage system should be used to reduce catheter-associated bacteriuria and infection 5
Institution-specific strategies should be developed to ensure that disconnection of the catheter junction is minimized and that the drainage bag and connecting tube are always kept below the level of the bladder 5

Multiple studies have shown that candiduria is a marker for greater mortality, but death is not related to Candida infection and treatment for Candida infection does not change mortality rates 1, 2
Candiduria rarely progresses to candidemia in most patient populations 1, 2

Antifungal prophylaxis should be considered when patients with candiduria undergo urinary tract instrumentation due to documented high rates of candidemia in this situation 1, 2