Asymptomatic candiduria in a renal transplant patients

Q: 46 years old patient with a history of successful kidney transplant about 6 years ago is admitted to ICU with chest pain and EKG changes. The night float intern sent urinalysis due to previous history though the patient did not have any urological complaints. The patient is found to have asymptomatic candiduria. Asymptomatic candiduria in a renal transplant is an absolute indication for the treatment.

A) True

B) False

Answer: B

Asymptomatic candiduria after renal transplantation is not an absolute indication for treatment, unless there is a high risk for graft involvement or the patient still carries a ureteral stent (like in the early phase of post-transplant).

A clinician may consider continuing management with an ultrasound of the KUB (Kidney, Ureter, Bladder) system to rule out any underlying possibility of fungus balls in high-risk patients like diabetics.

This conservative approach is to prevent resistant Candida infections in the future. A clinician should look for and reduce the risk factors that may be contributing to candiduria. If candiduria persists in the case of chronic bladder catheters or stents, replacement should be considered.

Patients who are required to undergo major surgery or have neutropenia may be considered for treatment at a provider's discretion.

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References:

1. Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.

2. Sobel JD, Kauffman CA, McKinsey D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis 2000; 30:19.

3. Jacobs DM, Dilworth TJ, Beyda ND, et al. Overtreatment of Asymptomatic Candiduria among Hospitalized Patients: a Multi-institutional Study. Antimicrob Agents Chemother 2018; 62.