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Question 32#

A 60-year-old female patient is admitted to the hospital in septic shock secondary to a urinary tract infection. The patient is started on antibiotics awaiting culture results. She improves with complete resolution of her symptoms. The patient continues to have a urinary catheter in place. On the 10th hospital day, the patient is discharged to a rehabilitation facility. As a part of the routine admission orders, urinalysis and culture are ordered. The patient denies fever, abdominal pain, nausea, or vomiting. The urinalysis shows 5 to 10 white blood cells and a negative dipstick for nitrite and leukocyte esterase, but the culture grows more than 10 5 colonies of Candida albicans. Which of the following is the best course of action?

A) Start antifungal therapy with fluconazole
B) Continue broad-spectrum antibiotics
C) Remove the urinary catheter
D) Encourage water intake and continue to observe
E) Remove the urinary catheter and start liposomal amphotericin B

Correct Answer is C

Comment:

Every positive culture requires interpretation. A positive culture could represent a pathogen, a colonizer, or a contaminant. The presence of symptoms and signs of infection in addition to supportive laboratory and radiologic data makes a cultivated microbe a pathogen. The patient has no symptoms or signs of infection and her urinalysis shows no pyuria. In this case, C albicans is a colonizer, and no antifungal therapy is indicated. Predisposing risk factors need to be eliminated to reduce the chances of colonization and to prevent a colonizer from becoming a pathogen. Removing a Foley catheter, controlling hyperglycemia and stopping broad-spectrum antibiotics, when feasible, represent some examples of risk factor elimination. Antifungal therapy (such as with fluconazole or amphotericin B) is inappropriate for fungal colonization alone.