Two Approaches to Treatment of Complicated Candida Glabrata Urinary Tract Infection in Renal Failure

Abstract

Objective:

To report the treatment of 2 cases of Candida glabrata urinary tract infection (UTI) in the setting of renal failure.

Case Summaries:

A 37-year-old female in acute renal failure developed a complicated UTI due to C. glabrata. The organism was eradicated after treatment with caspofungin. The second patient, a 58-year-old woman also in acute renal failure, developed a complicated UTI due to C. glabrata. This patient failed to eradicate the organism after repeated courses of voriconazole.

Discussion:

UTI caused by non-albicans Candida in the setting of renal failure presents few therapeutic options for management. Caspofungin and voriconazole have excellent activity against Candida spp., but have poor elimination as active drug in the urine. Amphotericin B is less feasible in the setting of acute renal failure, in which return of renal function is expected. Lipid-associated amphotericin products poorly penetrate the kidney. Despite these facts, one patient cleared the organism after treatment with caspofungin and one patient had persistent positive cultures after receiving voriconazole.

Conclusions:

Despite poor penetration into the urine, caspofungin may be an option in the management of UTI when other modalities are not feasible or desired.