Fungal İdrar Yolu Enfeksiyonları Tanı ve Tedavisi
Synopsis
Candida species are the most frequently isolated pathogens in fungal urinary tract infections, and candiduria, which is rare in healthy individuals, increases significantly among hospitalized patients, kidney transplant recipients, and neonates. Although C. albicans is the most common species identified, non-albicans Candida species with high antifungal resistance—such as C. glabrata, C. tropicalis, C. krusei, and C. parapsilosis—account for more than 50% of urine culture isolates. Urinary catheterization, broad-spectrum antibiotic use, congenital anomalies, calculi, diabetes, and immunosuppressive therapies are the major risk factors for candiduria development. Infection occurs via ascending or hematogenous routes; although most cases are asymptomatic, renal involvement can be complicated by pyelonephritis, abscess formation, and fungus balls causing urinary obstruction. Acute kidney injury and fungus ball formation are observed more frequently in neonates, with ultrasonography serving as an important diagnostic tool by detecting hyperechoic masses without acoustic shadowing. Suprapubic aspiration is the most reliable method to differentiate infection from colonization and contamination. Fluconazole is the first-line systemic treatment, whereas Amphoterisin-B is preferred in neonates; for obstructive fungus balls, nephrostomy, renal pelvis irrigation, or surgical intervention may be required. Removal of unnecessary catheters and limiting antibiotic usage constitute essential preventive measures.
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