Micafungin shown to be effective for candiduria
September 20 2016
Addressing a common problem in hospitals, Gabardi and colleagues show that intravenous micafungin eradicates candiduria in 75% of patients.
A recent shift in the epidemiology of candidiasis has been noted with an increase in the frequency of urinary tract infections (UTIs) caused by non-albicans Candida spp. commonly resistant to fluconazole. Echinocandins have fungicidal activity against Candida and penetrate well into the renal parenchyma. However, these agents achieve poor concentrations in the urine and are generally considered ineffective in the treatment of Candida UTIs.
In this retrospective analysis performed in two tertiary-care academic medical centers, 33 hospitalized patients with candiduria or Candida UTI who received micafungin and had follow-up urine cultures were evaluated. The most commonly recovered species were C. albicans (n=13) and C. glabrata (n=10). Twenty-five patients (75%) had an indwelling urinary catheter. UTI was diagnosed in 16 (48%). Only 3 (10%) had concomitant Candida bloodstream infection. Micafungin was used for a mean duration of 6 days.
Rates of urine sterilization during treatment, two weeks after treatment and more than one month after treatment were 81, 78 and 75%, respectively. Urine sterilization rates were similar between patients with C. albicans and non-albicans Candida spp., immunocompetent and immunocompromised patients as well as among patients with or without urinary catheter removal/replacement.
C.albicans cultured on sabaroud agar (CDC Public health library no. 3192)
This article adds to the limited existing literature on the use of echinocandins for candiduria. Small case series and case reports note some success, but failures have also occurred. In a series of 6 patients with symptomatic candiduria, caspofungin was successfully used; however, this was in the setting of hematogenous renal candidiasis and ascending pyelonephritis [Sobel et al, Clin Infect Dis 44(5):e46-e49]. Gabardi and colleagues performed the largest analysis to date on the eradication of candiduria using an echinocandin.
Their work is limited by the retrospective design of the study.