Candiduria in kidney transplant recipients: Is antifungal therapy useful?

• DOI: 10.1111/myc.12740
• Publication Date: 2017-12-27T09:04:44Z
• Authors: Blandine Denis; Dorothée Chopin; Prescillia Piron; Matthieu Resche‐R...; Stéphane Bretagne; Maud Gits‐Muselli; Marie‐Noelle Peraldi; Imad Abboud; Jean‐Michel Molina
• Keywords: Adult; Male; 0303 health sciences; Antifungal Agents; Incidence; Candidiasis; Middle Aged; Kidney Transplantation; Transplant Recipients; 3. Good health; 03 medical and health sciences; Treatment Outcome; Risk Factors; Urinary Tract Infections; Humans; Female; Aged; Candida; Proportional Hazards Models; Retrospective Studies

SummaryA French single‐centre retrospective study between 2010 and 2014 was undertaken to assess candiduria's incidence in kidney transplant recipients (KTR), and the use and impact of antifungal treatment on outcome. Candiduria was defined as a urine culture with ≥103 cfu/mL of Candida species. Candiduria clearance, severe complications and death rates were estimated by Kaplan‐Meier methods and the effect of treatment by Cox models.52/1223 (4.3%) KTR had ≥1 episode of candiduria, 42 (81%) were females, 18 (35%) had diabetes, with an incidence of 2.3/100 person‐year of follow‐up. Candiduria was asymptomatic in 51 (98%) patients. Candida glabrata was the most frequent pathogen identified. Overall fungal clearance rate was 89%. Antifungal therapy was initiated in only 14 episodes (12%), according to guidelines. Three patients (6%) developed severe complications in the first 2 weeks after transplantation, and 8 (15%) died. Antifungal treatment had no impact on candiduria clearance (HR, 0.6; 95% CI, 0.3‐1.1; P = .10), on recurrence rate (HR, 0.5; 95% CI, 0.1‐2.3; P = .41) and on the risk of severe complications or death (HR, 1.1; 95% CI, 0.3‐4.8; P = .89). Candiduria is rare and usually asymptomatic among KTR. Candiduria management in the immediate post‐transplant period deserves careful attention.