Candiduria in renal transplant recipients: incidence, clinical repercussion, and treatment indication.
BACKGROUND
The incidence of candiduria in renal transplant recipients is unknown. In clinical practice, the indications for antifungal therapy are not well established. Furthermore, there is the problem of the choice of the antifungal drug since some of them may select resistant Candida species, or interact with immunosuppressive agents or only be used intravenously.


OBJECTIVE
We sought to study the incidence, clinical repercussions and effectiveness of antifungal treatment to prevent recurrence of candiduria.


METHODS
We examined all episodes of Candida-positive urine cultures (>50,000 cfu/mL) in 996 recipients over 2 years. We considered the Candida species, administered treatment, presence of fever, requirement for hospital admission versus outpatient case, occurrence of simultaneous bacterial urinary tract infection (UTI), antibiotic use during the week before candiduria, and presence of an indwelling urinary catheter.


RESULTS
Among 996 subjects, 34 displayed 83 episodes of candiduria, yielding an accumulated incidence of 3.4% after 2 years. The frequency was higher among women (6.3% vs 1.7%, P<.001). Of the 45 outpatient episodes (54.2%), 17 were treated and one required hospitalization (5.9%). Of the 28 nontreated outpatients, two were hospitalized (7.1%, P=.68 vs treated patients). All cases of hospital admission presented simultaneous bacterial UTI, none developed candidemia, and two patients did not receive any antifungal therapy. With respect to the first episodes of each patient (n=34), 5/11 treated (45.5%) and 4/23 untreated (17.4%) patients developed recurrences (P=.095). Selection of more resistant Candida species was not observed. Fifty cases (60%) were associated with antibiotic therapy and 34 (41%) the presence of a urinary catheter.


CONCLUSIONS
It does not seem necessary to treat candiduria in this setting. Antifungal therapy was not associated with either a reduction in recurrence or the appearance of more resistant species in this study. We observed no important clinical repercussions.
Nephrology Department, Hospital Clínico San Carlos, Madrid, Spain. jdelgadodominguez@gmail.com
J
J
Delgado
N
N
Calvo
A
A
Gomis
I
I
Pérez-Flores
A
A
Rodríguez
N
N
Ridao
R
R
Valero
A I
AI
Sánchez-Fructuoso
D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000150:complications* / Q000188:drug therapy / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008297:Male; D012189:Retrospective Studies
D000935:Antifungal Agents