Management of Candida Non-albicans in Diabetic Patients

Clinical Significance and Epidemiology

Diabetic patients are at increased risk for candiduria, along with elderly individuals, females, those with indwelling urinary devices, patients taking antibiotics, and those who have had prior surgical procedures 1, 3
In asymptomatic diabetic patients, candiduria almost always represents colonization rather than infection, and elimination of underlying risk factors (such as indwelling catheters) is often adequate to eradicate candiduria 1
Multiple studies have shown that candiduria is a marker for greater mortality, but death is not related to Candida infection itself, and treatment for asymptomatic candiduria does not change mortality rates 1

Candiduria does not commonly lead to candidemia in most patients, including those with diabetes 1
However, certain high-risk situations warrant more aggressive management, such as when patients undergo urinary tract instrumentation (high risk of candidemia) 1
Neutropenic patients and those with very low birth weight are also at higher risk 1

Remove indwelling bladder catheter if present (strongly recommended) in asymptomatic diabetic patients with candiduria 1, 2
In most asymptomatic diabetic patients, no antifungal treatment is required 1
For symptomatic urinary tract infection, the Infectious Diseases Society of America recommends oral fluconazole, 200 mg (3 mg/kg) daily for 2 weeks for fluconazole-susceptible organisms (including most C. albicans) 1, 2
For fluconazole-resistant C. glabrata, treatment options include Amphotericin B deoxycholate or oral flucytosine 1, 2

The presence of candiduria in diabetic patients may be a marker of severity of underlying illness rather than a cause of morbidity itself 1
Avoid unnecessary treatment of asymptomatic candiduria, as it rarely progresses to invasive disease and treatment does not improve outcomes 1