Purpose of Review To provide a concise, practice-oriented synthesis on Candida urinary tract infections: epidemiology and clinical significance of candiduria; when candiduria reflects colonization vs. infection; pharmacology of key antifungals focused on urinary and renal tissue penetration; the roles of source control and urologic intervention; and management in special scenarios (pre-urologic procedures, obstruction, devices, and impaired renal function). Recent Findings Fluconazole remains first-line therapy for susceptible isolates given excellent urinary and renal penetration. Echinocandins and lipid amphotericin B achieve low urinary concentrations and may be unreliable for treatment of cystitis, whereas amphotericin B deoxycholate and flucytosine attain therapeutic urinary concentrations (with nephrotoxicity and hematologic toxicity considerations). Novel agents such as rezafungin, fosmanogepix, oteseconazole, ibrexafungerp and encochleated amphotericin B show promising PK/tissue distribution but there are limited data defining their potential role in treating lower-tract disease. Intravesical or nephrostomy instillation of amphotericin B can produce short-term clearance in resistant or device-associated infections, yet relapse is common without addressing obstruction or removing/exchanging hardware. Pre-procedural candiduria may increase postoperative complications in selected populations; short-course targeted therapy is reasonable before intermediate-/high-risk genitourinary interventions. Renal impairment requires dose adjustment for fluconazole and flucytosine, avoidance of cyclodextrin-containing IV azoles, and preference for lipid amphotericin when a polyene is needed. Summary The work up of candiduria should prioritize confirming infection, prompt source control (catheter/device management, relief of obstruction), and organism-directed therapy. Treat selectively: many asymptomatic cases resolve with device measures alone; symptomatic or high-risk situations are best treated with fluconazole when active, or amphotericin B deoxycholate or flucytosine for resistant species. Reserve local instillation for carefully chosen cases. Coordinated ID–urology care and procedure-specific planning reduce relapse and complications; key gaps include standardized instillation regimens and trials defining who benefits from antifungal therapy and the role of novel antifungals.

Management of Candida Infections of the Urinary System

期刊论文
出版模式：

开放获取
发表日期：

2026年4月21日

查看全文

Adam G. Stewart,
Sarah P. Hammond

摘要

Purpose of Review

To provide a concise, practice-oriented synthesis on Candida urinary tract infections: epidemiology and clinical significance of candiduria; when candiduria reflects colonization vs. infection; pharmacology of key antifungals focused on urinary and renal tissue penetration; the roles of source control and urologic intervention; and management in special scenarios (pre-urologic procedures, obstruction, devices, and impaired renal function).

Recent Findings

Fluconazole remains first-line therapy for susceptible isolates given excellent urinary and renal penetration. Echinocandins and lipid amphotericin B achieve low urinary concentrations and may be unreliable for treatment of cystitis, whereas amphotericin B deoxycholate and flucytosine attain therapeutic urinary concentrations (with nephrotoxicity and hematologic toxicity considerations). Novel agents such as rezafungin, fosmanogepix, oteseconazole, ibrexafungerp and encochleated amphotericin B show promising PK/tissue distribution but there are limited data defining their potential role in treating lower-tract disease. Intravesical or nephrostomy instillation of amphotericin B can produce short-term clearance in resistant or device-associated infections, yet relapse is common without addressing obstruction or removing/exchanging hardware. Pre-procedural candiduria may increase postoperative complications in selected populations; short-course targeted therapy is reasonable before intermediate-/high-risk genitourinary interventions. Renal impairment requires dose adjustment for fluconazole and flucytosine, avoidance of cyclodextrin-containing IV azoles, and preference for lipid amphotericin when a polyene is needed.

Summary

The work up of candiduria should prioritize confirming infection, prompt source control (catheter/device management, relief of obstruction), and organism-directed therapy. Treat selectively: many asymptomatic cases resolve with device measures alone; symptomatic or high-risk situations are best treated with fluconazole when active, or amphotericin B deoxycholate or flucytosine for resistant species. Reserve local instillation for carefully chosen cases. Coordinated ID–urology care and procedure-specific planning reduce relapse and complications; key gaps include standardized instillation regimens and trials defining who benefits from antifungal therapy and the role of novel antifungals.