Do you recommend treating Candida albicans on urine culture from an indwelling catheter in a patient with septic shock?

In a patient with septic shock, one is typically obligated to treat all things until further culture data is back, etc. If there are other clear causes of shock, I would not treat the candida (though I would try to change the catheter ASAP). If the patient is extremely ill and no other sources of infection are found, I would treat the candida initially, though look for other causes, as it would be unlikely for candida to cause septic shock. I would likely treat for 24-48 hours pending other culture data and the ability to change the catheter, but once the catheter is changed and other cultures return (and show no evidence of candidemia for example), I would stop the antifungal.

Rarely a problem unless candidemia.

C albicans is a common, generally asymptomatic, fungus in individuals with a chronic indwelling Foley. A rare cause of septic shock. Yet “common” and “rare” are statistical probabilities, not certainties. In individuals with potentially high morbidity and mortality septic shock, we generally treat for all recovered potential pathogens until an alternative site and pathogen are identified. On a practical basis, this translates into 2 or 3 days of a generally well-tolerated azole such as fluconazole, with very little downside, until a more likely site of infection and pathogen is identified.

Rarely would I treat unless I believed the patient was at high risk for candidemia and the cultures were still maturing. If the patient has anatomical abnormalities of the GU tract, Candida can form a bezoar and lead to downstream complications, so I would consider imaging or further evaluation to look for these complications of candiduria if any such anatomical issues are present.