Fungal Urinary Tract Infections Research Articles

A review on urinary tract infection

Urinary tract infections (UTIs) are a common infection that affects women at various stages of life, with women experiencing an 8:1 higher rate than males. By the age of 24, one person in three experienced once in their life symptomatic UTI requiring antibiotic treatment. Women make up the bulk of annual doctor visits and are especially vulnerable to UTIs. Gram-positive and gram-negative bacteria, along with certain fungi, can be transmitted through urinary tract infections. Pathogenic Escherichia is the most frequent cause of both simple and complex UTIs. Other common causes include klebsiella pneumoniae, Eter coccus fecal is, group B Streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. A prevalent UTI pathogen in young women is S. saprophyticus. Fungal UTIs are also becoming more common, especially those brought on by Candida species and, to a lesser degree, Aspergillus species and Cryptococcus neoformans. Recurrent UTIs are defined as more than two symptomatic episodes in a six-month period or more than three symptomatic episodes in a 12-month period. The largest risk factor for recurrent UTIs in young women is the frequency of sexual activity. Risk factors include genetic, age-specific, pregnancy-related, behavioral, vulnerability, and urine catheterization variables. Urine culture, microscopic urinalysis, and dipstick urinalysis are the three primary tests used in laboratory analysis for UTIs. Clinicians can identify UTIs more precisely by adjusting the pretest probability of UTI based on urine dipstick and microscopic urinalysis results. Empirical treatment tends to be successful for women who experience dangerous urine symptoms and a high posttest likelihood; cultural confirmation may not be warranted.

Distribution and antifungal susceptibility of Candida species causing vulvovaginal candidiasis and urinary tract infection in Medlatec healthcare system, Ha Noi city, Vietnam in 2023.

Vulvovaginal candidiasis and urinary tract infections caused by Candida are common diseases. While the most common causative agent is C. albicans, other species, such as non-C. albicans, can also be responsible. Susceptibility to antifungal drugs varies among Candida species, but there is very limited information available from Vietnam. To determine the species distribution and antifungal susceptibility patterns of Candida isolated from urine and vaginal samples of patients tested at the Medlatec healthcare system in 2023. Cross-sectional study. The study describes a cross-sectional analysis of over 102 Candida isolates obtained from urine and vaginal samples of patients using the testing services at Vietnam Medlatec healthcare system from January to December 2023. Species identification of Candida isolates was performed using germ tube test and Vitek® 2 systems. Antifungal susceptibility testing was carried out using the VITEK® 2 card for yeast fungi. Minimum inhibitory concentrations for these isolates were classified according to the Clinical and Laboratory Standards Institute guidelines (M27-A3 and M27M44S-ED3). In this investigation, five different Candida species were identified. Among these isolates, C. albicans (78.43%) was the most frequent, followed by C. tropicalis (11.76%), C. glabrata (4.91%), C. parapsilosis (1.96%), and C. krusei (0.98%). The resistance rates to fluconazole, voriconazole, caspofungin, micafungin, and amphotericin B were 7.7%, 4.2%, 4.0%, 1.0% and 1.0%, respectively. The most common species found in this population was C. albicans. Our findings also showed a high frequency of non-albicans Candida species causing fungal urinary tract infections. The resistance rates of isolated Candida strains to echinocandins and amphotericin B were low, while some strains were found to be resistant to fluconazole and voriconazole.

The diagnostic efficacy of rapid urine sediment fluorescence staining in urinary tract infections: An exploratory study

The diagnostic efficacy of rapid urine sediment fluorescence staining in urinary tract infections: An exploratory study

Elucidation of the mechanisms of fluconazole resistance and repurposing treatment options against urinary Candida spp. isolated from hospitalized patients in Alexandria, Egypt

BackgroundThe incidence of fungal urinary tract infections (UTIs) has dramatically increased in the past decades, with Candida arising as the predominant etiological agent. Managing these infections poses a serious challenge to clinicians, especially with the emergence of fluconazole-resistant (FLC-R) Candida species. In this study, we aimed to determine the mechanisms of fluconazole resistance in urinary Candida spp. isolated from hospitalized patients in Alexandria, Egypt, assess the correlation between fluconazole resistance and virulence, and explore potential treatment options for UTIs caused by FLC-R Candida strains.ResultsFluconazole susceptibility testing of 34 urinary Candida isolates indicated that 76.5% were FLC-R, with a higher prevalence of resistance recorded in non-albicans Candida spp. (88.9%) than in Candida albicans (62.5%). The calculated Spearman’s correlation coefficients implied significant positive correlations between fluconazole minimum inhibitory concentrations and both biofilm formation and phospholipase production. Real-time PCR results revealed that most FLC-R isolates (60%) significantly overexpressed at least one efflux pump gene, while 42.3% significantly upregulated the ERG11 gene. The most prevalent mutation detected upon ERG11 sequencing was G464S, which is conclusively linked to fluconazole resistance. The five repurposed agents: amikacin, colistin, dexamethasone, ketorolac, and sulfamethoxazole demonstrated variable fluconazole-sensitizing activities in vitro, with amikacin, dexamethasone, and colistin being the most effective. However, the fluconazole/colistin combination produced a notable reduction (49.1%) in bladder bioburden, a 50% decrease in the inflammatory response, and tripled the median survival span relative to the untreated murine models.ConclusionsThe fluconazole/colistin combination offers a promising treatment option for UTIs caused by FLC-R Candida, providing an alternative to the high-cost, tedious process of novel antifungal drug discovery in the battle against antifungal resistance.

Uropathogenic Candida: Microbial profile and antifungal sensitivity patterns in a tertiary care hospital in Vadodara, Gujarat

Fungal urinary tract infections (UTIs) are commonly caused by species, with albicans historically recognized as the most frequently isolated species. Differentiating between mere colonization and true infection—identifying whether the is a uropathogen or a commensal—is essential for appropriate clinical management. Antifungal sensitivity testing is critical in guiding effective treatment, particularly in the face of increasing resistance. The objective of this study was to analyze the microbial profile of candiduria, distinguish between uropathogenic and commensal isolates, and evaluate their Antifungal sensitivity patterns at a tertiary care hospital in Vadodara, Gujarat. This retrospective study was conducted over a one-year period, from January 1, 2022, to December 31, 2022. A total of 9,227 urine samples from patients suspected of having UTIs were analyzed. Isolation and identification of species were performed using established microbiological methods, including culture on selective media and biochemical testing. Antifungal sensitivity testing was conducted following the Clinical and Laboratory Standards Institute (CLSI) guidelines using the broth microdilution method. Patient clinical data were reviewed to differentiate uropathogenic isolates from commensals based on factors such as colony counts, presence of symptoms, and associated risk factors. Out of the 9,227 urine samples analyzed, 2,751 (29.82%) exhibited significant microbial growth, with species isolated in 67 (2.43%) of these cases. Of the 67 isolates, 45 (67.16%) were identified as uropathogens, while 22 (32.84%) were categorized as commensals. albicans was identified in 24 (35.82%) of the isolates, while non-albicans species accounted for 43 (64.18%), including (25.37%), (20.90%), (11.94%), and (5.97%). Antifungal sensitivity testing showed high sensitivity to echinocandins (caspofungin and micafungin), with varying resistance patterns observed for azoles and amphotericin B among different species. The study reveals a predominance of non-albicans species in cases of candiduria and emphasizes the importance of accurate species identification and Antifungal sensitivity testing. Differentiating between uropathogenic and commensal isolates is vital for guiding appropriate treatment. Continuous monitoring is necessary to detect emerging resistance trends and to inform treatment strategies.

ANTIFUNGAL ACTIVITY OF GARLIC EXTRACT ON FUNGI ASSOCIATED WITH URINARY TRACT INFECTIONS AMONG FEMALE STUDENTS OF JOSEPH SARWUAN TARKA UNIVERSITY

Researchers from all around the world are becoming more interested in the medicinal properties of plant extracts. Since modern medicine has its own benefits and drawbacks, plant-based solutions are becoming more and more popular since they are risk-free, readily available, and reasonably priced. The main purpose of this study was to determine the antifungal activity of garlic (Allium sativum) extract on fungi associated with urinary tract infections among female students of Federal University of Agriculture Makurdi. Garlic cloves were purchased from North Bank market and were transported to Microbiology Laboratory. They were blended into paste and were extracted using maceration method. Urine samples collected were analyzed using standard microbiological methods. Extract concentrations from 500mg/mL-100mg/mL were prepared using a double standard dilution method. About 50 urine samples were collected and the fungi present in the urine were isolated using standard microbiological methods. Susceptibility analysis of the fungal isolates was done using the aqueous and ethanolic garlic extract, and the zones of inhibitions obtained at the various concentrations were compared with a positive control (fluconazole). Analysis of data obtained was done using a Statistical Package for Social Science (SPSS). The result showed a mean zone of inhibition of 17.6×10± 1.00×10 mm at a concentration of 500mg/mL, 13.6×10 ± 1.52×10 mm at a concentration of 250mg/mL and 22.0×10 ± 1.00x10mm for the positive control (fluconazole) on Candida albicans using the aqueous garlic extract while for the ethanolic garlic extract showed a mean zone of inhibition of 18.3x10±1.52×10mm at a concentration of 500mg/mL 13.0×10 ± 2.00×10 mm at 250mg/mL. The mean zones of inhibition for 200mg/mL, 125mg/mL, and 100mg/mL were 9.67x10±5.77×10 mm, 7.67×10 ±5.77×10 mm and 3.67×10± 5.77×10mm respectively. Garlic extract has potential antifungal activity on the isolated urinary tract organisms and as such can be used as a natural antifungal agent in the control of fungal urinary tract infections.

Distribution of yeasts in fungal urinary tract infections from a tertiary care hospital

Aims: Urinary tract infections caused by fungi in critically ill patients steadily increasing in recent years. Fungiuria is a marker of contamination, colonization, or infection in the lower or upper urinary tract. As urinary catheters especially long-term usage was the most important risk factor for fungiuria. The identification of yeast isolates at the species level is crucial for the appropriate management of infection. We conducted this study to describe the epidemiological features of fungiuria in patients. Methods: The yeast species were identified by using conventional methods and automated systems. Demographic data were recorded from the electronic medical records. Results: Candida albicans, were predominant compared to non-albicans Candida species and yeast-like fungi. Among non-albicans Candida, the most common species were Candida tropicalis followed by Candida glabrata complex. Fungiuria was more common in females than in males. Underlying conditions were present in patients the most common risk factors were antibiotic therapy before the detection of yeasts and using a urinary catheter. Conclusion: Epidemiological data and antimicrobial therapy play an important role in the treatment of urinary tract infections. For this reason, the identification of fungi at the species level is critical to assist the decision on antifungal therapy in complex cases. In all patients with fungal growth in urine culture, the underlying risk factors should be evaluated first. Depending on the correction of risk factors, fungiuria may resolve spontaneously. This is seen as the best approach both to reduce treatment costs and to prevent resistance to antifungals.

Современные подходы к лечению и профилактике грибковой инфекции мочевых путей

Современные подходы к лечению и профилактике грибковой инфекции мочевых путей

An Alternative Urinary Tract Irrigation Method in Children with Fungal Urinary Tract Infections

An Alternative Urinary Tract Irrigation Method in Children with Fungal Urinary Tract Infections

SGLT2 inhibitors reduce adverse kidney and cardiovascular events in patients with advanced diabetic kidney disease: A population-based propensity score-matched cohort study

SGLT2 inhibitors reduce adverse kidney and cardiovascular events in patients with advanced diabetic kidney disease: A population-based propensity score-matched cohort study

Voriconazole Associated Hypertension: A Case Report

Objective: The study report a case of a young female with candida tropicalis and candida krusei infection who developed severe hypertension after she had repeated received voriconazole for few days.
 Case Presentation: A 23-year-old female was admitted to hospital because of recurrent urinary tract infection. She underwent horseshoe nephrectomy, extracorporeal lithotripsy treatment and double J-tube placement in the past 5 years. After multiple surgeries, she developed recurring fungal urinary tract infections and underwent anti-infective treatment. Twenty days ago, the patient developed chills, fever, dizziness, fatigue, urinary tract irritation signs and bilateral low back pain. Urine culture suggests Candida croco (resistant to fluconazole). After taking antifungal therapy with voriconazole 300 mg q12h, the patient experienced an unexplained increased blood pressure and transient loss of consciousness.
 The patient began to experience an increase in blood pressure (140-160/90-100 mmHg) on the second day of voriconazole treatment. After 5 days of taking voriconazole, the patient developed fatigue, dizziness and blurred vision with persistent hypertension (150/100 mmHg), and temporary loss of consciousness and syncope on day8, when blood pressure was measured at 175/95 mmHg.
 Conclusion: This case illustrates that acute blood pressure elevation may manifest in patients taking normal doses of voriconazole, which deserves the attention of clinicians.

Clinical practice guideline for the diagnosis and management of urinary tract infections: 2022 update

In 2015, the "New recommendations regarding the current controversies in urinary infection" were published in the Archivos Argentinos de Pediatría. Given the fact that in these past years, new evidence has emerged regarding the diagnosis and treatment of urinary infection, the Pediatric Nephrology Committee of Sociedad Argentina de Pediatría has decided to update these recommendations. The main goal is to provide the pediatrician with the necessary tools to make a correct diagnosis, define the most appropriate treatment, select the patients who will benefit from antibiotic prophylaxis, and decide which imaging studies will be necessary, avoiding costly and invasive interventions. These guidelines also include the management of children with urinary tract infections associated with special situations such as: bladder bowel dysfunction, the newborn, children with neurogenic bladder, kidney transplant patients and fungal urinary tract infections.

P133 Post-COVID-19 recurrent fungal urinary tract infections: A case series

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM BackgroundCOVID-19 has opened a pandora's box of opportunistic infections and immune alteration. We hereby present a series of patients with recurrent fungal urinary tract infections triggered by an episode of COVID-19.DescriptionCase 1: A 66-year-old male, diabetic, known chronic kidney disease, had moderate COVID-19 in September 2020 needing remdesivir and steroids; 2 months later, he was treated for a fungal UTI elsewhere. In May 2021, he presented with right-sided pyelonephritis, hydroureter, and pyonephrosis. DJ stenting was done and cultures grew C. tropicalis. Record of anti-fungal susceptibility from the fluconazole resistance and was hence treated with 21 days of micafungin with significant improvement. Despite 3 weeks of directed anti-fungal treatment, he had recurrent episodes of candiduria with azotemia. Cystoscopy and selective sampling yielded C. tropicalis from the right pelvi-calyceal system, but as he was unwilling for nephrostomy and local antibiotic instillation he was started on anidulafungin and long-term 5-flucytosine suppression.Case 2: A 61-year-old male, diabetic, with uncontrolled sugars, had severe COVID-19 in September 2020 needing oxygen, remdesivir, and steroids; 1 month later, presented with right-sided flank pain and four episodes of painless passage of fleshy tissue per urethra in the last 1 year (Fig. 2). He had multiple episodes of bacterial UTIs which were treated, with complete resolution. The fleshy mass showed septate fungal elements and culture grew Aspergillus flavus sensitive to voriconazole, itraconazole, and posaconazole. He received multiple prolonged courses of voriconazole and caspofungin prior to presenting to us. CT revealed right-sided pyelonephritis with dilated pelvi-calyceal system. The patient was started on 2 weeks of micafungin followed by a prolonged course of voriconazole and 5-flucytosine with close clinical and therapeutic drug monitoring.Case 3: A 68-year-old female, diabetic, had moderate COVID-19 in April 2021, and was given remdesivir and steroids. She was admitted 1 month later with UTI (Pyelonephritis with early forming renal abscess) with urine culture growing CR Klebsiella p. (OXA-48) and C. glabrata for which she was given ceftazidime-A, vibactam, and voriconazole and underwent bilateral DJ stenting followed by stent removal after 1 month along with switching to micafungin in view of repeated candiduria on treatment. She has developed multiple UTIs in the subsequent months with C. auris being isolated twice and bacterial UTIs, treated with antibiotics and micafungin. Subsequent CT revealed retroperitoneal fibrosis encasing the ureters causing obstruction, a biopsy was inconclusive but was empirically started on methotrexate for IgG4 disease.DiscussionThe proposed immune alteration mechanism of COVID-19 of decreased phagocytic function, uncontrolled sugars, and steroid-related neutrophil dysfunction predisposes to several opportunistic infections including fungal infections. It is intriguing that these patients with refractory funguria never underwent any instrumentation The challenges associated with the management of these cases included deranged renal functions precluding the use of intravenous contrast for imaging and several anti-fungal drugs; inadequate urinary penetration of antifungals especially with deranged renal functions and hesitancy with local instillation of antibiotics, and the need for repeated surgical intervention including insertion of stents in an infected urinary tract.

Fungal Urinary Tract Infections in Pediatric Age Groups

One of the most prevalent and recurring bacterial diseases in kids is urinary tract infections (UTI). At least 8% of girls and 2% of boys are thought to suffer UTIs as children. The fungi are often linked to UTIs, and their antibiotic susceptibility patterns change over time and across various environments. To choose the best empirical antimicrobial therapy, it is crucial to understand the trends of uropathogenic antibiotic resistance in certain geographic areas. Therefore, this research assesses the causal organisms in urine samples and their antibiotic susceptibility profile among patients who visit Mosul's general outpatient department clinic. Due to space restrictions, our research primarily focused on fungus-related UTIs in children (2–12) years old. . Adult infections, reflux nephropathy, catheter-associated and nosocomial infections, medication assessment for particular antimicrobials, and viral and rickettsial infections are only a few examples of the subjects covered. The study intends to close a gap in the literature about how candiduria manifests in pediatric inpatients and outpatients. The current study's objective was to ascertain the prevalence of candiduria among kids visiting External laboratories in Mosul, Iraq. Additionally, isolates' sensitivity to several antifungal medications was taken into consideration.

Sequencing of ca-int-l gene of Candida Spp. In infected urinary tract among Iraqi women

The most common nosocomial fungal infection in hospitals is urinary tract candidiasis. Candida albicans is the most prevalent cause of nosocomial fungal urinary tract infections, however Candida species distribution is changing rapidly. At the same time, the rise in urinary tract candidiasis has resulted in the emergence of antifungal-resistant Candida species. This study aimed to diagnose Candida Spp. In women with UTI and reveal the nucleotides sequences of CA-INT-L Gene to look for mutation within the gene. This study included 100 women patients suffering from urinary tract infections and vaginal swabs samples from those individuals were taken to identify the presence of Candida. They were between the ages of 22 and 67. Candida identification has been accomplished using a variety of chemical and microscopically techniques. 100 samples have been clinically diagnosed with Candida Spp. But only 62 of the samples were positive by Vitik. This number has also reduced to only 25 after using the PCR. The sequence of the CA-INT-L showed different variations within the gene of the isolates.

Fungal urinary tract infection in outpatient practice: approaches to diagnosis and treatment

Introduction. In recent years, the role of fungal infection in inpatient and outpatient patients has been increasing. At the same time, there are currently no recommendations on the duration of treatment of outpatient patients with fungal urinary tract infection (UTI). Aim of the study. Optimization of methods of diagnosis and treatment of outpatient patients with fungal UTI.Materials and methods. To detect fungi in urine, the E. Koneman et al. (1997) method was improved. 56 patients with fungal UTI were examined. The efficacy of fluconazole in the treatment of fungal UTI was studied in 53 patients.Results. Candida albicans was detected in 37% of cases of fungal UTI in outpatient patients. Risk factors for fungal UTI in outpatient patients include: antibacterial therapy, infravesical obstruction, type 2 diabetes mellitus and the presence of urinary drainage. The microbiological efficacy of fluconazole therapy for 7, 10 and 14 days was 83.0%, 94.3% and 96.2%, respectively. The growth of fungi in the urine a month after treatment was absent in 86.7% of patients. In outpatient patients with fungal UTI without type 2 diabetes mellitus, the efficacy of fluconazole at a dose of 150 mg per day for 7 days was 94.9%. In patients with type 2 diabetes mellitus after 7 days of therapy, the efficacy was 50.0%.Conclusions. The most common causative agent of fungal UTI in outpatient patients is Candida albicans. To detect fungi in urine, samples should be seeded on selective media, while increasing the seeding volume to 0.1 ml and extending the incubation time to 96 hours. Fluconazole is a highly effective treatment for fungal UTI at a dose of 150 mg per day for 7 days, however, in patients with diabetes mellitus, therapy should last at least 10 days.

Etiotropic therapy of fungal urinary tract infection in outpatient practice

Etiotropic therapy of fungal urinary tract infection in outpatient practice

Fungal Urinary Tract Infection; A Study Conducted On Patients With Liver Cirrhosis

Objective: To determine frequency of fungal infection of urinary tract in patients with liver cirrhosis Design & duration: This is a cross sectional study. This study was completed in duration of six months. Setting: Study was conducted in Margalla Hospital Gulshan Colony PMO, Taxila. Patients & Methods: Patients admitted in study hospital with liver cirrhosis having child class A, B and C were evaluated for fungal urinary tract infection, belonging to any gender, having age above 40 years. All data was documented and analyzed using SPSS software version-20 and means, frequencies, standard deviation and p-value were calculated. Results presented in the form of tables and graphs. Results: Total 400 cases were evaluated for fungal urinary tract infection having liver cirrhosis admitted in study hospital in given duration of study. Fungal cause of UTI was found in 260 cases including 29.3% male and 70.7% female cases. While other causes were found in 140 cases. According to child classification out of 260 cases with fungal UTI, 11 cases were in class B and 249 cases were in class-C while no case belonged to class-A. Most of the cases (42%) with UTI were in age interval of 40-50 years. Duration of CLD was 2-4 years in most of the cases (30%). Conclusion: Fungal cause of urinary tract infection is very common among patients with liver cirrhosis and older age as these cases have week immunity Key words: Liver cirrhosis, chronic liver disease, urinary tract infection, fungal infection, immunocompromised

Investigating Candida glabrata Urinary Tract Infections (UTIs) in Mice Using Bioluminescence Imaging.

Urinary tract infections (UTIs) are quite common and mainly caused by bacteria such as Escherichia coli. However, when patients have urinary catheters, fungal infections comprise up to 15% of these types of infections. Moreover, fungal UTIs have a high mortality, due to rapid spreading of the fungi to the kidneys. Most fungal UTIs are caused by Candida species, among which Candida albicans and Candida glabrata are the most common. C. glabrata is an opportunistic pathogenic yeast, phylogenetically quite close to Saccharomyces cerevisiae. Even though it is commonly isolated from the urinary tract and rapidly acquires resistance to antifungals, its pathogenesis has not been studied extensively in vivo. In vivo studies require high numbers of animals, which can be overcome by the use of non-invasive imaging tools. One such tool, bioluminescence imaging, has been used successfully to study different types of C. albicans infections. For C. glabrata, only biofilms on subcutaneously implanted catheters have been imaged using this tool. In this work, we investigated the progression of C. glabrata UTIs from the bladder to the kidneys and the spleen. Furthermore, we optimized expression of a red-shifted firefly luciferase in C. glabrata for in vivo use. We propose the first animal model using bioluminescence imaging to visualize C. glabrata in mouse tissues. Additionally, this UTI model can be used to monitor antifungal activity in vivo over time.

Antimicrobial resistance among fungi from patients with urinary tract infections in Ojo, Lagos, Nigeria

The incidence of fungal urinary tract infections has risen gradually and has thus constituted a public health challenge. The aim of this study was to determine the prevalence of urinary tract infections by fungi in two health centres in Ojo, Lagos. A total of 200 patients attending the health centers constituting 160 males’ urines and 40 females’ vaginal swabs were recruited for this study. Midstream urine samples and vaginal swabs were aseptically collected and processed using standard mycological techniques. Fungal isolates were identified based on cultural characteristics, lactophenol blue stain, chlamydospore formation, colony colour on CHROM agar Candida medium and API yeast identification. Antifungal susceptibility testing of the isolates was performed by using the Broth dilution and Kirby-Bauer disk diffusion methods using two of the most commonly used antifungal agents. A total of 122 fungal isolates, of which 68 (55.7%) were Candida spp. and 54(44.3%) Aspergillus spp. were recovered. The Candida spp. included 64 (52.5%) C. albicans and 4(3.3%) C. glabrata while Aspergillus spp. included A. flavus, 20(16.4%), A. fumigatus, 24 (19.8%) and A niger, 10(8.2%). The most common fungal pathogens in the urinary tracts of the subjects were Candida albicans and Aspergillus fumigatus. Both C. albicans and A. fumigatus were highly susceptible to both fluconazole and amphotericin B in dimethyl sulphoxide and water (90-100%). Similarly, all Aspergillus spp. were susceptible to both antifungals except A. flavus which showed a slight resistance (10-15%), which appears to be emerging. Both fluconazole and amphotericin B still show high chances of therapeutic efficacy against fungal infections of the urinary tracts.