Candiduria in kidney transplant recipients: is antifungal therapy useful?

Summary

A French single-center retrospective study between 2010-2014 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 female, 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=0.10), on recurrence rate (HR, 0.5; 95% CI, 0.1-2.3; p=0.41) and on the risk of severe complications or death (HR, 1.1; 95% CI, 0.3-4.8; p = 0.89). Candiduria is rare and usually asymptomatic among KTR. Candiduria management in the immediate post-transplant period deserves careful attention.

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