This patient has asymptomatic candiduria, which requires no antifungal therapy. Candiduria is a common finding in patients in the ICU. Candida albicans is the most common colonizing and infecting species, and most strains are fluconazole susceptible. The presence of candiduria may represent a contaminated urine sample, colonization of the bladder or catheter, upper or lower urinary tract infection (UTI), or a manifestation of candidemia rather than true UTI. In patients who have candiduria and an indwelling urinary catheter, the catheter should be removed, if possible, and a urine sample obtained several days later to assess whether the candiduria has resolved. If the catheter cannot be removed, it should be replaced and a urine sample collected through the new catheter. Most patients with candiduria are asymptomatic, and asymptomatic candiduria rarely results in candidemia. Asymptomatic candiduria should not be treated with antifungal agents except in certain populations at risk for candidemia, including patients who are neutropenic or who are undergoing urinary tract procedures. Patients who have symptoms of UTI should be treated. If treatment becomes necessary, oral fluconazole is the drug of choice.

Amphotericin B and flucytosine are less desirable alternatives to fluconazole. Local instillation of amphotericin B into the bladder is effective in eliminating the organism, but the effect is short lived and guidelines on the management of urinary tract candidiasis do not recommend it except for a few situations, including as adjunctive treatment for Candida glabrata or Candida krusei cystitis.

The echinocandins (micafungin, anidulafungin, and caspofungin), voriconazole, and posaconazole are not recommended for treatment of Candida UTI because very little active drug is found in the urine.