Micafungin Therapy for Symptomatic Candiduria in Hospitalized Patients: A Review of 14 Cases

Fluconazole is the drug of choice for candiduria requiring treatment; however, it may not be optimal in some cases because of resistance, drug interactions, or adverse effects. Case reports and retrospective analyses suggest that echinocandins may be effective in treating candiduria and Candida urinary tract infections, despite low urinary concentrations. The purpose of this investigation was to evaluate the effectiveness of echinocandins for the treatment of Candida urinary tract infections in hospitalized patients. This was a 5-year, retrospective evaluation of patients treated with micafungin for Candida urinary tract infections (symptomatic) or asymptomatic candiduria with qualifying conditions (pregnancy, neutropenia, recent urologic procedure). The primary outcome was clinical success, defined as symptom resolution (symptomatic patients) or urine sterilization (asymptomatic patients) by the end of treatment. Secondary outcomes included urine sterilization in all patients and time to symptom resolution. A total of 302 patients with candiduria received micafungin during the study period. Of these, 97 met the inclusion criteria; however, 83 were excluded. Fourteen patients were included in the case series. Twelve patients (85.7%) were symptomatic, and 2 (14.3%) were asymptomatic with neutropenia. Ten patients (71.4%) achieved the primary outcome of symptom resolution or urine sterilization by the end of treatment. Six patients (42.9%) had urine sterilization by the end of therapy; however, a follow-up urine culture was not performed in the remaining 8 patients. Median time to symptom resolution was 4 days. In some clinical settings, micafungin may be an effective therapy for Candida urinary tract infections in hospitalized patients.