An 80-year-old resident of a nursing home has severe dementia, type 2 diabetes mellitus and a chronic indwelling Foley catheter which is in place to manage his persistent incontinence. He has no remarkable medical history and is quite healthy except for his dementia. He has received antibiotics for presumed urinary tract infection twice in the last year.
The nursing home staff decided to obtain a urinalysis and urine culture: they call you because the urine culture is growing Candida albicans with a colony count of 100,000 cfu/ml. His UA shows 30-40 WBC and 10-20 RBC per HPF, with a 1+ leukocyte esterase.
He is in his usual state of health with no fever, no urinary symptoms that you can elicit from him, and no flank tenderness.
What would you recommend?
A. Observe and do nothing more unless the patient becomes symptomatic
B. Observe but obtain repeat urinalysis and culture in one week
C. Change Foley catheter and give oral fluconazole for 1 week
D. Change Foley catheter and IV caspofungin for 1 week
E. Change the Foley catheter and order Amphotericin B deoxycholate bladder washes daily for 5-7days
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