Comparison of Amphotericin B Bladder Irrigations Versus Fluconazole for the Treatment of Candiduria in Intensive Care Unit Patients.
BACKGROUND
Funguria occurs often in hospitalized patients and is most commonly caused by Candida species. Fluconazole is the agent of choice for most Candida urinary tract infections. Amphotericin B bladder irrigations (ABBI) are an alternative treatment option.


OBJECTIVE
The purpose of this study is to assess the efficacy of ABBI compared to fluconazole for the treatment of candiduria in the intensive care unit (ICU) setting.


METHODS
We conducted a retrospective chart review of patients admitted to ICUs at our institution with a positive urine culture for Candida species between 2005 and 2012. All patients receiving ABBI were included; patients receiving fluconazole for treatment of candiduria were matched by year. The primary endpoint was achievement of cure.


RESULTS
There was no difference in cure between the ABBI and fluconazole groups (59.6% vs. 52.8%, p = 0.55). Clearance was higher in patients receiving ABBI (92.3% vs. 67.9%, p < 0.001). Logistic regression found that renal dysfunction predicted greater cure with ABBI therapy compared to fluconazole (OR 7.63, 95% CI 1.81-32.1).


CONCLUSIONS
ABBI was equally efficacious in achieving overall cure, and resulted in greater clearance of candiduria compared to fluconazole. ABBI may be considered an alternative to fluconazole for the treatment of candiduria and may be preferred over fluconazole in patients with renal dysfunction.
1 Neurointensive Care/Neurosurgery, Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA.
Kelly A
KA
Sullivan
2 Neurointensive Care, Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Meghan M
MM
Caylor
3 Department of Biostatistics, North Carolina Translational and Clinical Sciences (NC TraCS) Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Feng-Chang
FC
Lin
4 Medicine Intensive Care, Department of Pharmacy, University of North Carolina Hospitals, Chapel Hill, NC, USA.
Stacy
S
Campbell-Bright
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D015725:Fluconazole / Q000008:administration & dosage*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects* / Q000382:microbiology; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole
amphotericin B; candiduria; fluconazole; intensive care unit; urinary tract infection