Candiduria, or yeast in the urine, is commonly encountered in the intensive care unit (ICU) setting. Risk factors for candiduria include increased age, female sex, urinary drainage catheters, antibiotic use, prior surgical procedures, and diabetes mellitus. Detection of the Candida species of yeast in the urine can represent colonization or infection and distinguishing between the two can be difficult because of the lack of appropriate diagnostic tests. Clinical findings used to diagnose bacterial infections of the lower urinary tract are not applicable to candiduria because patients are often asymptomatic and yeast colony counts and pyuria do not correlate with infection. Most of the time, candiduria is a benign process. However, caution is warranted because candiduria may represent disseminated or upper urinary tract infection in certain high-risk ICU patients.

The Infectious Diseases Society of America’s guidelines for treatment of candidiasis recommend antifungal treatment of candiduria in the following circumstances: symptomatic patients; patients who will undergo urinary tract manipulation; patients with neutropenia; patients with renal allografts; and infants with low birth weight. Treatment of these select patients might reduce the risk of ascending infection and/or disseminated infection or might treat occult disseminated candidiasis. In addition, antifungal treatment should be considered for patients with candiduria who have urinary tract obstruction or an abnormal urinary tract, patients who are to have surgery to implant prosthetic devices [e.g., valves, joints, ventricular assist devices (VADs)], and critically ill patients who already have implanted VADs.