Fungal urinary tract infections in the elderly - Treatment guidelines

The finding of fungal growth in the urine (funguria) of elderly patients is becoming increasingly common. It has been reported in both acute and chronic care settings. Risk factors for the development of funguria include the use of broad spectrum antibiotics, corticosteroids and indwelling bladder catheters, as well as diabetes mellitus, urological abnormalities and haematological malignancies. The presence of signs and symptoms of infection are unusual and the intensity of fungal growth in culture does not correlate with outcome. Careful assessment of the patient's clinical status should be undertaken before treatment is initiated as the majority of cases resolve when underlying risk factors are addressed. Current recommendations for treatment include bladder irrigation with amphotericin B, oral fluconazole or a single dose of intravenous amphotericin B.