Evaluation of efficacy and tolerance of intravesical amphotericin B irrigation for the management of Candiduria.

Abstract

Introduction: Candiduria, is becoming increasingly common among hospitalized and immunocompromised patients. This infection poses a therapeutic challenge due to the rise in fluconazole resistance among Candida species. When fluconazole is unsuitable due to resistance or drug interactions, amphotericin B (AmB) is recommended. However, AmB's systemic use is limited by nephrotoxicity, which has led to interest in intravesical (bladder-administered) AmB.

Methods: A retrospective study was conducted at Reims University Hospital on adult patients treated with intravesical AmB. Patient demographics, infection characteristics, and treatment details were extracted from medical records. Efficacy was determined by the absence of candiduria or rehospitalization, and renal safety was evaluated through serum creatinine and renal clearance before and after treatment. Adverse effects were graded by severity.

Results: Sixteen patients were included (10 female patients (62.5%), mean age 69.8±15 years). Eight patients (50.0%) were admitted in urology department and diabetes mellitus was present in 9 patients (56.2%). Candida glabrata, resistant to fluconazole, was the most frequently isolated organism. Intravesical AmB was administered at a standard dose of 50mg diluted in 1 liter of sterile water, delivered over 24hours among almost all patients. Two patients were rehospitalized. Among patients with follow-up urine cultures, 66% (4 out of 6) achieved candiduria eradication. Two patients reported minor adverse effects, including mild catheter-related discomfort. No significant increase of serum creatinine level was observed after treatment.

Discussion and conclusion: Intravesical AmB appear effective and safe for treating fluconazole-resistant candiduria, especially in high-risk, elderly patients. While promising, these findings are based on a small sample, highlighting the need for larger studies with prospective design to further elucidate the optimal management strategies for candiduria in vulnerable patients.