Clinical Medicine Insights: Trauma and Intensive Medicine

Objective: Candiduria is very common in critically ill patients. It is often benign; however, it can develop into a serious systemic infection and treatment is suggested in symptomatic critically ill patients. The optimal duration of therapy is unclear. Long-term therapy (14 days) is recommended by the current guidelines, but previous data suggest that shorter-duration therapy may be effective. Minimizing the use of antifungal agents is desirable to avoid fungal resistance and adverse events. The purpose of this study was to determine the efficacy of short-term treatment of candiduria.

Methods: This was an observational study in medical, surgical, and trauma intensive care unit (ICU) and ICU step-down patients. A pathway utilizing a 3-day course of fluconazole for candiduria was implemented. The candiduria recurrence rate was compared in patients treated before (control groups with short-term, ie, ≤3 days, or long–term, ie, ≥7 days, therapy) and after the implementation of the pathway (study group: ≤3 days).

Results: Thirty-seven study patients were compared to 59 control patients. There were statistically no differences in the recurrence rate for candiduria among study patients, control patients with long-term therapy, and control patients with short-term therapy (32% vs 55% vs 38%, respectively; P > 0.05).

Conclusion: Three days of fluconazole treatment for candiduria appeared to be as effective as long-term therapy in this population.