Candiduria in kidney transplant recipients: Is antifungal therapy useful?

Summary A 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 ≥10 3  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.