Study Finds Hospitalized Candiduria Patients Are Not Treated According to Clinical Guidelines

Fungi belonging to the genus Candida are commonly found in the urine of hospitalized patients. It is often challenging for physicians to decide on the course of treatment for patients with candiduria as most patients are asymptomatic. In fact, oftentimes the only way physicians can detect asymptomatic candiduria is through the ordering of urine cultures, which frequently occurs without a clear need.

Earlier studies have shown that treating asymptomatic candiduria can occur through the elimination of the underlying risk factors, as opposed to treating with antifungal therapy. Antifungal therapy for those with asymptomatic candiduria is only recommended for high-risk patient populations, such as those with neutropenia. However, although antifungal therapy is often not recommended for patients with asymptomatic candiduria, many of these patients still receive antifungal drugs, which can lead to a whole host of problems, such as selecting for antifungal-resistant organisms as well as adverse side effects.

In a new study published in Antimicrobial Agents and Chemotherapy by lead investigator David M. Jacobs, PharmD, Clinical Assistant Professor at the University of Buffalo, and his colleagues sought to determine if the management of candiduria among hospitalized patients is in compliance with the guidelines set forth by the Infectious Disease Society of America (IDSA). Secondly, the authors sought to evaluate clinical outcomes for patients diagnosed with candiduria, such as recurrence rates and hospital readmission rates.

The retrospective cohort study included 305 random patients that were hospitalized with candiduria at four medical centers in the United States between January 2010 and December 2013. The average age of the patients in the study was 69 years and the majority of patients (67%) were female. The patients were categorized as either asymptomatic or symptomatic based on established criteria. The authors found that 143 out of the 305 patients were not managed properly as per the IDSA guidelines; these included 43% of the asymptomatic group and 61% of the symptomatic group.

For the asymptomatic candiduria group, the major reason for non-adherence to IDSA guidelines was that patients received antifungal therapy when there was no indication for the treatment. On the other hand, for the symptomatic candiduria group, reasons for non-adherence included improper antifungal drug choice, improper dosage, and failure to administer the antifungal agent even when therapy was indicated. Moreover, patients in the symptomatic candiduria group were predominately treated with fluconazole with improper doses and for shorter time periods than recommended by the IDSA. In addition, patients did not receive AmB deoxycholate or flucytosine, which are recommended alternatives.

In terms of patient outcomes, asymptomatic patients who were not managed according to IDSA guidelines showed a higher trend towards candiduria recurrence and 30-day hospital readmission. However, the authors note that this trend is non-significant. On the other hand, the authors did not note a significant difference in clinical and microbiological outcomes among patients with symptomatic candiduria based on guideline adherence.

Overall, the authors demonstrated that around half of the candiduria patients included in the study were not managed according to IDSA guidelines and many of the patients were over-treated with the antifungal drug fluconazole.

Samar Mahmoud graduated from Drew University in 2011 with a BA in Biochemistry and Molecular Biology. After two years of working in the industry as a Quality Control Technician for a blood bank, she went back to school and graduated from Montclair State University in 2016 with an MS in Pharmaceutical Biochemistry. She is currently pursuing a PhD in Molecular and Cellular Biology at the University of Massachusetts at Amherst.