title: [Candiduria! What now? : Therapy of urinary tract infections with Candida].
abstract: BACKGROUND
  Yeasts are found in urine specimens relatively often, especially in the elderly and patients under treatment with broad spectrum antibiotics, i. e. especially in intensive care unit (ICU) patients. In some cases, the number of pathogens is very high, i. e. >105/ml. The clinical relevance of detecting Candida in urine is difficult to assess. In the German S3 guidelines it is apodictically stated that an ascending infection of the urinary tract by yeasts does not occur but this may undoubtedly happen in certain instances in patients at risk, for example in the elderly, in diabetic persons and in the case of foreign bodies in the urinary tract. A hematogenous spread of yeasts can lead to pyelonephritis, which accompanies candiduria. In rare cases this can be induced by prostatitis and epididymitis. Therapy is indicated in all cases when a urological manipulation is planned, particularly those with injury to the mucosal barrier, in order to prevent an intraoperative spread of pathogens.
  
  
  OBJECTIVE
  The antimicrobial agents suitable for therapy of candiduria are limited, namely flucytosine, amphotericin B, which is also used for irrigation and fluconazole.
  
  
  METHODS
  The in vitro effect of nitroxoline on 100 isolates of yeasts from urine was tested by an agar diffusion test.
  
  
  RESULTS
  Nitroxoline exerted a good activity against all yeast isolates.
  
  
  CONCLUSIONS
  The antibiotic nitroxoline has a good antifungal activity. It achieves high concentrations in urine and in addition, it is effective at low pH as well as against pathogens in biofilms, which most antimycotics cannot achieve. Hence, nitroxoline is suitable for termination of candiduria. Foreign bodies in the urinary tract, on which biofilms are formed, should be removed whenever possible.
authors: MVZ Labor Dr. Limbach und Kollegen, Im Breitspiel 15, 69126, Heidelberg, Deutschland. herbert.hof@labor-limbach.de.
authors: H
authors: H
authors: Hof
mesh_terms: D000293:Adolescent; D000328:Adult; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D002175:Candida / Q000187:drug effects*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009600:Nitroquinolines / Q000008:administration & dosage*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D015003:Yeasts / Q000187:drug effects*; D055815:Young Adult
chemical_list: D000892:Anti-Infective Agents, Urinary; D000935:Antifungal Agents; D009600:Nitroquinolines; C005308:nitroxoline
keywords: Amphotericin B; Broad spectrum antibiotics; Fluconazole; Flucytosin; Nitroxoline