A case of pyelonephritis and bacteremia caused by Candida glabrata in a patient on sodium glucose cotransporter 2 inhibitor, successfully treated with micafungin.

backgroundBackground factors for Candida spp. detection in urine include indwelling urinary catheters, diabetes mellitus, and a history of antimicrobial exposure; nevertheless, urinary tract infections caused by Candida spp. are usually rare. Fluconazole (FLCZ) is a preferable drug for the treatment of urinary tract infections caused by Candida spp.; however, some cases of urinary tract candidiasis resistant to FLCZ have been observed, making the selection of a therapeutic agent difficult. Recently, an increase in fungal genital infections has been reported alongside the increase in the use of sodium glucose cotransporter 2 (SGLT2) inhibitors. Although these medications have not been shown to increase urinary tract infections, concerns persist that they may promote colonization of the genital tract by Candida spp. and cause retrograde urinary tract infections, particularly in women. This is a rare case of Candida glabrata induced pyelonephritis and bacteremia in a patient receiving SGLT2 inhibitors, successfully treated with micafungin (MCFG). CASE PRESENTATION: A patient in her 70s under active treatment for breast cancer was diagnosed with a urinary tract infection and bacteremia caused by C. glabrata. The patient was taking SGLT2 inhibitors, and had no history of urinary catheter placement or antimicrobial exposure. In order to avoid the side effects of amphotericin B (AmB) and flucytosine (5-FC), the patient was treated with MCFG and FLCZ for 17 days. No adverse events or recurrence were recorded over the subsequent three months.

conclusionsPatients taking SGLT2 inhibitors may be more susceptible to urinary tract infections caused by Candida glabrata, and in cases of azole-resistant Candida spp. urinary tract infection, MCFG may be a treatment option when AmB or 5-FC is difficult to use.